National Provider Identifier Database

SHAKER PEDIATRICS PC
Adolescent Medicine

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.

Contact Information

SHAKER PEDIATRICS PC
10 CENTURY HILL DRIVE
LATHAM, NY  12110
Phone: 518-783-5563
Fax: 518-785-5708
Website:
Specialty Taxonomy Code
* Adolescent Medicine 2080A0000X

* Indicates primary specialty

NPI Profile & details for SHAKER PEDIATRICS PC

NPI Number 1336156223
Legal business name
LBN		 SHAKER PEDIATRICS PC
Authorized official HENRY NEILLEY - (FIRST VICE PRESIDENT)
Entity Organization
Organization subpart No
Enumeration date 08/02/2006
Last updated 08/22/2020 - About 6 years ago
Sole proprietor1 Not specified
Identifiers
  • NY Medicaid: 00392741
  • NY Medicaid: 00962767
  • NY Medicaid: 01260746
  • NY Medicaid: 01332856
  • NY Medicaid: 01762674
  • NY Medicaid: 02094695
  • Other: 000401569001 BS HENRY NEILLEY MD
  • Other: 000401340001 BS SHEELA GRANEY MD
  • Other: 000401387001 BS WILLIAM A PETERSEN MD
  • Other: 10044836 CDPHP DAVID SHERWOOD MD
  • Other: 1007 CDPHP GROUP
  • Other: 10001463 CDPHP HENRY NEILLEY MD
  • Other: 10002139 CDPHP MARYLA WARSZAWA-AMB
  • Other: 10021167 CDPHP SHEELA GRANEY MD
  • Other: 10002804 CDPHP WM A PETERSEN MD
  • Other: 349679 MVP DAVID SHERWOOD MD
  • Other: 26207 MVP HENRY NEILLEY MD
  • Other: 26210 MVP MARYLA WARSZAWA-AMB
  • Other: 964787 MVP SHEELA GRANEY MD
  • Other: 26208 MVP WILLIAM A PETERSEN MD

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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