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General NPI Number Information
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NPI Number | 1215498522
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Entity Type | Individual
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Provider Name | BRIGITTE SHEZELLE REINA MD
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Gender | Female
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Dates
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Enumeration Date | 03/28/2019
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 583 S CLARIZZ BLVD
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City | BLOOMINGTON
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State | IN
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Zip | 47401-5515
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Country | US
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Telephone | 812-676-4460
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Fax | 812-355-4092
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Provider Business Mailing Address
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Address Line | 855 W 6TH ST APT 11
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City | WINSTON SALEM
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State | NC
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Zip | 27101-2538
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084E0001X
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Taxonomy Name | Epilepsy Physician
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License Number | 01094423A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2084N0008X
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Taxonomy Name | Neuromuscular Medicine (Psychiatry & Neurology) Physician
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License Number | MD220351
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | BP10082676
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 01094423A
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License Number State | IN
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