Healthcare Provider Details

I. General information

NPI: 1962507798
Provider Name (Legal Business Name): SHAHDOKHT REEDER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 UNION ST STE 106
NATICK MA
01760-7700
US

IV. Provider business mailing address

67 UNION ST STE 106
NATICK MA
01760-7700
US

V. Phone/Fax

Practice location:
  • Phone: 781-666-2711
  • Fax: 781-666-2712
Mailing address:
  • Phone: 781-666-2711
  • Fax: 781-666-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number229433
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN226028
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number226028
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: