SHANE TATAR PA
NPI 1770932303
Physician Assistant - Medical in Merrick, NY

Q: What is the provider's specialty?

The provider's specialty is Physician Assistant with taxonomy code 363AM0700X and a focus in Medical.

Active since June 04, 2016PECOS Enrolled

389 MERRICK AVE, MERRICK, NY 11566(516) 867-5132(516) 867-5519 Get Directions Write a Review

NPPES record last updated: May 23, 2023. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Shane Tatar Pa NPPES

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

SHANE TATAR PA (NPI 1770932303) is an individual medical provider in Merrick, New York, licensed in New York (019324) and active in the NPI registry since June 2016. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1770932303

Entity TypeIndividualMale

Primary Taxonomy363AM0700X

Provider Legal NameSHANE TATARCredential: PA

Location Address389 MERRICK AVEMerrick, NY 11566-2723

Mailing Address221 Broadway, 207Amityville, NY 11701-2780 · (631) 598-0009 · Fax (631) 598-0099

Phone(516) 867-5132

Fax(516) 867-5519

Sole ProprietorNo

Enumeration DateJune 4, 2016

Last NPPES UpdateMay 23, 2023

NPPES CertifiedMay 23, 2023

✔ NPI 1770932303 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

License✔ Licensed in NY · 019324

389 MERRICK AVE, Merrick, NY 11566

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Shane Tatar Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.