Individual ProviderShanti MarshallNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address2015 Grand Concourse, Bronx, NY 10453(718) 299-7295(718) 618-0401PECOS EnrollmentBased on the most recent information from CMS, provider Shanti Marshall is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1528362761Provider TypeIndividualFull NameMarshall, ShantiGenderFemaleSole ProprietorYesEnumeration Date1/3/2011Last Updated2/11/2019Contact InformationPractice LocationPractice Address2015 Grand Concourse, Bronx, NY 10453Phone(718) 299-7295FaxUnlisted FaxMailing LocationMailing Address3198 Grand Concourse, Bronx, NY 10458-1000Phone(718) 618-0401FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseF343633New YorkCode163W00000XDescriptionRegistered NurseNursing Service ProvidersLicense628411-1New YorkProvider IdentifiersIDDescriptionIssuerID02386450DescriptionMedicaidIssuerUnlistedNew York