LAUREL J SHAMBO (NPI# 1871881649) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871881649 |
| Entity Type | Individual |
| Full Name | LAUREL J SHAMBO |
| Credential | PA |
| Practice Address |
9732 State Route 12 Copenhagen NY 13626-2906 |
| Mailing Address |
Po Box 2337 Syracuse NY 13220-2337 |
| Practice Telephone | 3156882305 |
| Mailing Telephone | 3157015607 |
| Mailing Fax Number | 3157015608 |
| Enumeration Date | 2011-07-14 |
| Last Update Date | 2012-03-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 015328 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | P80534 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 03417452 | 05 |
| Street Address |
9732 STATE ROUTE 12 |
| City | COPENHAGEN |
| State | NY |
| Zip Code | 13626-2906 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649251489 | Roger Brian Shambo | Family Medicine | 9732 State Route 12, Copenhagen, NY 13626-2906 | 2005-11-09 |
| 1215133491 | Roger B Shambo, Md, LLC | Family Medicine | 9732 State Route 12, Copenhagen, NY 13626-0026 | 2007-06-25 |
| 1376529651 | Norman Bruce Scott | Family Medicine | 9732 State Route 12, Copenhagen, NY 13626-2906 | 2005-12-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487159125 | Tonya Jean Farrell | Licensed Practical Nurse | 9860 Nys Rt 12, Apt 2, Copenhagen, NY 13626 | 2018-03-26 |
| 1316003023 | Copenhagen Central School | Local Education Agency (LEA) | 3020 Mechanic Street, Copenhagen, NY 13626 | 2006-12-28 |
| 1780003889 | Corey Ameele | Chiropractor | 101 School Street, Copenhagen, NY 13626-0162 | 2014-04-16 |
| 1609013218 | Mary K Greene | Speech-Language Pathologist | 2988 Cataract St., Copenhagen, NY 13626-0286 | 2009-01-20 |
| 1235749979 | Lewis County General Hospital | Clinic/Center | Copenhagen Health Center, 9732 State Route 12, Copenhagen, NY 13626-1362 | 2020-08-07 |
| 1619510799 | Kristine Baker | Marriage & Family Therapist | 10138 Washington St, Copenhagen, NY 13626-2814 | 2019-10-22 |
| 1710367891 | Melinda Iketau | Counselor | 9502 State Route 12, Apt 3, Copenhagen, NY 13626-2904 | 2015-06-04 |
| 1639590821 | Rachel L Slate | Licensed Practical Nurse | 14858 Odell Rd, Copenhagen, NY 13626-3175 | 2013-12-15 |
| 1982176327 | Jennifer Ercle Gardner | Registered Nurse | 391 Denning Rd, Copenhagen, NY 13626-3403 | 2018-12-26 |
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144821026 | Victoria Yunaev | Physician Assistant | 7203 166th St, Fresh Meadows, NY 11365-3237 | 2020-11-05 |
| 1811598857 | Brittany Christine Androsko | Physician Assistant | 1769 Union St Fl 2, Niskayuna, NY 12309-6311 | 2020-11-05 |
| 1164023172 | Betina Charlotte Apostol Nuguid | Physician Assistant | 1730 Central Park Ave Ste 3p, Yonkers, NY 10710-4905 | 2020-11-05 |
| 1023619129 | Anna Leigh Vonck | Physician Assistant | 2 Executive Park Dr Ste 2, Albany, NY 12203-3700 | 2020-11-04 |
| 1952902256 | Billy Phuoctan Truong | Physician Assistant | 8832 18th Ave, Brooklyn, NY 11214-6002 | 2020-11-03 |
| 1205437621 | Jason Patrick Feak | Physician Assistant | 6338 Falls Blvd, Chittenango, NY 13037-8799 | 2020-11-03 |
| 1437750742 | Drew James Mitchell | Physician Assistant | 58 Old Bedford Rd, Goldens Bridge, NY 10526-1000 | 2020-11-03 |
| 1306446125 | Julie Mcphillips | Physician Assistant | 961 W Kaisertown Rd, Montgomery, NY 12549-2317 | 2020-10-30 |
| 1487254330 | Thomas J Nagel | Physician Assistant | 57 Montgomery Road, Fort Montgomery, NY 10922 | 2020-10-29 |
| 1700486560 | Jayanti Rao | Physician Assistant | 1059 Union St Apt 3g, Brooklyn, NY 11225-1268 | 2020-10-29 |
| Find all providers with the same taxonomy | ||||
| City | COPENHAGEN |
| Zip Code | 13626 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.