Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Shain S Wallis, DO

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1356653729

Dr. Shain S Wallis, DO is a Diagnostic Radiology in Liverpool, New York. Qualified in 2005, 21 years ago. Practices with Prospect Hill Radiology Group P C, a 15-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
21
Licensed in
NY
In the registry since
2010
Specialties on file
2
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

5100 W Taft Rd Ste 2A
Liverpool, NY 13088
Phone: (315) 452-2666
Fax: (315) 452-2669
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Diagnostic Radiology Physician (primary) Taxonomy 2085R0202X · Licence 264957 (NY)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1356653729
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedJuly 13, 2010
Last updated in NPPESJanuary 29, 2024
Certification dateJanuary 29, 2024
Mailing address4567 Crossroads Park Dr, Liverpool, NY 13088-3589

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDIAGNOSTIC RADIOLOGY
Medical schoolOTHER
Graduated 2005 (21 years in practice)
Group practice Prospect Hill Radiology Group P C — 15 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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