Shelisha Roach, NP is a medicare enrolled "Radiology - Vascular & Interventional Radiology" in Amityville, New York. Her current practice location is
18 Matthew Dr, Amityville, New York. You can reach out to her office (for appointments etc.) via phone at
(631) 662-8474.
Shelisha Roach is licensed to practice in New York (license number 314571-01) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1629627708.
Provider's Profile
| Full Name | Shelisha Roach |
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| Gender | Female |
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| Speciality | Radiology - Vascular & Interventional Radiology |
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| Location | 18 Matthew Dr, Amityville, New York |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1629627708
- Provider Enumeration Date: 09/10/2019
- Last Update Date: 06/27/2025
Medicare PECOS Information:
- PECOS PAC ID: 7719362581
- Enrollment ID: I20220914001865
Medical Identifiers
Medical identifiers for Shelisha Roach such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1629627708 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 163W00000X | Registered Nurse | RN799197 (Pennsylvania) | Secondary |
| 163W00000X | Registered Nurse | 736087 (New York) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | SP032385 (Pennsylvania) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | F349466 (New York) | Secondary |
| 2085R0204X | Radiology - Vascular & Interventional Radiology | 314571-01 (New York) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Shelisha Roach allows following entities to bill medicare on her behalf.
| Entity Name | Fulton Medical Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1841635133
PECOS PAC ID: 8527201540
Enrollment ID: O20130823000424 |
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| Entity Name | Daniel S Berman Md Infectious Diseases Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1972018208
PECOS PAC ID: 2567723562
Enrollment ID: O20180308002033 |
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| Entity Name | Daniel Novick Md Pllc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1770327447
PECOS PAC ID: 0143754341
Enrollment ID: O20241111002856 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Shelisha Roach is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Shelisha Roach, NP
18 Matthew Dr,
Amityville, NY 11701-1718
Ph: () - | Shelisha Roach, NP
18 Matthew Dr,
Amityville, NY 11701-1718
Ph: (631) 662-8474 |
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