Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Shane William Wasden, MD

Individual provider Maternal & Fetal Medicine Physician · NPI 1104083096

Dr. Shane William Wasden, MD is an Obstetrics/Gynecology in New York, New York. Graduated from George Washington University School of Medicine in 2007, 19 years ago. Practices with North Shore-Lij Medical PC, a 6,350-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
19
Trained at
George Washington University School of Medicine
Licensed in
NY
In the registry since
2008
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

130 E 77th Street 2 Black Hall
New York, NY 10075-1007
Phone: (212) 434-2585
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Maternal & Fetal Medicine Physician (primary) Taxonomy 207VM0101X · Licence 250329 (NY)

Record details

NPI number1104083096
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMay 19, 2008
Last updated in NPPESApril 27, 2023
Certification dateApril 27, 2023

Medicare enrollment

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

Medicare specialtyOBSTETRICS/GYNECOLOGY
Medical schoolGEORGE WASHINGTON UNIVERSITY SCHOOL OF MEDICINE
Graduated 2007 (19 years in practice)
Group practice North Shore-Lij Medical Pc — 6350 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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