Healthcare Provider Details

I. General information

NPI: 1700722352
Provider Name (Legal Business Name): SHOMARI RELIFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 APPLEWOOD RD
BLOOMFIELD CT
06002-1814
US

IV. Provider business mailing address

20 APPLEWOOD RD
BLOOMFIELD CT
06002-1814
US

V. Phone/Fax

Practice location:
  • Phone: 203-885-6216
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2227
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: