SHANNON PHAN
NPI 1063368272
Counselor - Mental Health in Fayetteville, NY
NPI Status: Active since March 09, 2026
Contact Information
4000 MEDICAL CENTER DRIVE
SUITE 504
FAYETTEVILLE, NY
ZIP 13066
Phone: (315) 329-2650
- Individual
- Female
- Counselor
- Mental Health
About SHANNON PHAN
This page provides the complete NPI Profile along with additional information for Shannon Phan, a provider established in Fayetteville, New York with a medical specialization in Counselor, focusing in mental health . The healthcare provider is registered in the NPI registry with number 1063368272 assigned on March 2026. The practitioner's primary taxonomy code is 101YM0800X with license number P133718 (NY). The provider is registered as an individual and her NPI record was last updated March 2026. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization.
- NPI
- 1063368272
- Provider Name
- SHANNON PHAN
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 4000 MEDICAL CENTER DRIVE SUITE 504 FAYETTEVILLE, NY 13066
- Location Phone
- (315) 329-2650
- Mailing Address
- 8584 MCNAMARA DR CLAY, NY 13041
- Mailing Phone
- (315) 414-1252
- Is Sole Proprietor?
- Yes
- Enumeration Date
- 03-09-2026
- Last Update Date
- 03-09-2026
- Code Navigator
A mental health counselor like Shannon Phan provides treatment to individuals, families, couples, and groups for mental and emotional health issues and relationship problems. Mental health counselors treat clients with a variety of conditions, including anxiety, depression, grief, low self-esteem, stress, and suicidal impulses.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Counselor Mental Health
- Taxonomy Code
- 101YM0800X
- Type
- Behavioral Health & Social Service Providers
- License No.
- P133718
- License State
- NY
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1063368272, we treat the final digit (2) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 58. The final step is to find the difference between that total and the next multiple of ten (60 - 58 = 2).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 58 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 8 providers are registered at the same or a nearby location.
FAYETTEVILLE, NY 13066
FAYETTEVILLE, NY 13066
FAYETTEVILLE, NY 13066
FAYETTEVILLE, NY 13066
FAYETTEVILLE, NY 13066
FAYETTEVILLE, NY 13066
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1063368272, enumerated as an "individual" on March 09, 2026.
The provider is located at 4000 MEDICAL CENTER DRIVE SUITE 504 FAYETTEVILLE, NY 13066 and the phone number is (315) 329-2650.
Counselor with taxonomy code 101YM0800X and a focus in Mental Health.
