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Shadi Izmikna

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

475 Seaview Ave, Staten Island, NY 10305-3436

PECOS Enrollment

Based on the most recent information from CMS, provider Shadi Izmikna is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 6 days ago.

Profile Details

Provider ID
1326817263
Provider Type
Individual
Full Name
Izmikna, Shadi
Title
Mr.
Credential
PA-C

Gender
Male
Sole Proprietor
No
Enumeration Date
12/20/2023
Last Updated
2/12/2025

Contact Information

Practice Location

475 Seaview Ave, Staten Island, NY 10305-3436

(718) 226-6400

Unlisted Fax

Mailing Location

15 Mulberry Cir, Staten Island, NY 10314-3715

(917) 805-1399

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 031638 New York

Shadi Izmikna

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Vitulli, Vincent Anthony

Sommers, Stephanie

West, Lara Maria

Gregory, Krista Ann

Pantelios, Alexandra Katherine

Liconti, Dorin

Perazzo, Marina

Shkandriy, Tetyana

Cho, Eunice

Harris, Karen