Healthcare Provider Details

I. General information

NPI: 1538846035
Provider Name (Legal Business Name): SHELBY RAE REINHARDT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10625 W NORTH AVE STE 101B
WAUWATOSA WI
53226-2315
US

IV. Provider business mailing address

10625 W NORTH AVE STE 101B
WAUWATOSA WI
53226-2315
US

V. Phone/Fax

Practice location:
  • Phone: 414-877-5350
  • Fax:
Mailing address:
  • Phone: 414-877-5350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number838923
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: