SHAKER PEDIATRICS PC - NPI 1336156223 - Pediatrics in Latham, NY

Q: What is Shaker Pediatrics PC's NPI number?

The NPI number for Shaker Pediatrics PC is 1336156223. It was assigned to this organization in the NPPES registry on August 2, 2006.

Q: What is Shaker Pediatrics PC's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Adolescent Medicine, with taxonomy code 2080A0000X.

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About Shaker Pediatrics Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHAKER PEDIATRICS PC (NPI 1336156223) is a healthcare organization registered as an adolescent medicine in Latham, New York and active in the NPI registry since August 2006. The organization lists Henry M Neilley, First Vice President, as its authorized official.

NPPES Registry Identity

NPI1336156223

Entity TypeOrganization

Primary Taxonomy2080A0000X

Legal Business NameSHAKER PEDIATRICS PC

Location Address10 CENTURY HILL DRIVELatham, NY 12110

Mailing Address10 Century Hill DriveLatham, NY 12110 · (518) 783-5563 · Fax (518) 785-5708

Phone(518) 783-5563

Fax(518) 785-5708

Organization SubpartNo

Authorized OfficialHenry M NeilleyFirst Vice President · (518) 783-5563

Enumeration DateAugust 2, 2006

Last NPPES UpdateAugust 22, 2020

✔ NPI 1336156223 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Adolescent MedicineAllopathic & Osteopathic Physicians

Taxonomy Code2080A0000X

Definition

A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.

10 CENTURY HILL DRIVE, Latham, NY 12110

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Other Identifiers 20

Medicaid02094695NY

Other349679Mvp David Sherwood Md

Other000401569001Bs Henry Neilley Md

Other1007Cdphp Group

Other964787Mvp Sheela Graney Md

Other000401387001Bs William A Petersen Md

Medicaid01332856NY

Other10044836Cdphp David Sherwood Md

Medicaid00392741NY

Other000401340001Bs Sheela Graney Md

Medicaid01260746NY

Other10001463Cdphp Henry Neilley Md

Other10002804Cdphp Wm A Petersen Md

Other10021167Cdphp Sheela Graney Md

Other26207Mvp Henry Neilley Md

Other26208Mvp William A Petersen Md

Other10002139Cdphp Maryla Warszawa-amb

Other26210Mvp Maryla Warszawa-amb

Medicaid00962767NY

Medicaid01762674NY

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 33D0161435

Shaker Pediatrics · Latham, NY

Expired · Jun 9, 2026

CLIA Number33D0161435

Laboratory TypePhysician Office

Certificate Effective DateJune 10, 2024

Certificate Expiration DateJune 9, 2026

Laboratory DirectorDr. Sheela Graney

Laboratory Phone(518) 783-5563

Laboratory LocationShaker Pediatrics10 Century Hill Drive, Suite 5, Latham, NY 12110

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shaker Pediatrics PC's NPI number?

The NPI number for Shaker Pediatrics PC is 1336156223. It was assigned to this organization in the NPPES registry on August 2, 2006.

Where is Shaker Pediatrics PC located?

Shaker Pediatrics PC is located at 10 Century Hill Drive, Latham, NY 12110. The listed phone number is (518) 783-5563.

What is Shaker Pediatrics PC's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Adolescent Medicine, with taxonomy code 2080A0000X.

When was this NPI record last updated?

The NPPES record for Shaker Pediatrics PC was last updated on August 22, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.