Healthcare Provider Details

I. General information

NPI: 1942844949
Provider Name (Legal Business Name): SHANDEL REITH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2068 BRIDGEPORT AVE STE D
MILFORD CT
06460-4634
US

IV. Provider business mailing address

2068 BRIDGEPORT AVE STE D
MILFORD CT
06460-4634
US

V. Phone/Fax

Practice location:
  • Phone: 475-549-1260
  • Fax:
Mailing address:
  • Phone: 475-549-1260
  • Fax: 949-868-3855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8629
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8629
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10.136002
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: