MRS. SHANTELLE BROKAW (NPI# 1114462561) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114462561 |
| Entity Type | Individual |
| Full Name | MRS. SHANTELLE BROKAW |
| Practice Address |
128 Cedar Ave Waterbury CT 06705-2700 |
| Mailing Address |
500 Albany Ave Hartford CT 06120-2508 |
| Practice Telephone | 2037579271 |
| Mailing Telephone | 8602499625 |
| Mailing Fax Number | 8608081580 |
| Enumeration Date | 2016-12-21 |
| Last Update Date | 2020-04-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
6831 | CT | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
128 CEDAR AVE |
| City | WATERBURY |
| State | CT |
| Zip Code | 06705-2700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982072062 | Waterbury Gardens Nursing and Rehab LLC | Skilled Nursing Facility | 128 Cedar Ave, Waterbury, CT 06705-2700 | 2015-09-08 |
| 1558818559 | Grace Archibald | Occupational Therapist | 128 Cedar Ave, Waterbury, CT 06705-2700 | 2016-09-07 |
| 1447625330 | Katherine Molter | Occupational Therapy Assistant | 128 Cedar Ave, Waterbury, CT 06705-2700 | 2015-12-03 |
| 1740654961 | Amanda L Barry | Student in an Organized Health Care Education/Training Program | 128 Cedar Ave, Waterbury, CT 06705-2700 | 2015-11-27 |
| 1346614617 | Chris Pinnette | Occupational Therapy Assistant | 128 Cedar Ave, Waterbury, CT 06705-2700 | 2015-11-24 |
| 1528432895 | Michael Rivers | Occupational Therapist | 128 Cedar Ave, Waterbury, CT 06705-2700 | 2015-11-24 |
| 1376917708 | Alban Cota | Physical Therapy Assistant | 128 Cedar Ave, Waterbury, CT 06705-2700 | 2015-11-23 |
| 1215309679 | Waterbury Gardens Nursing and Rehab LLC | Nursing Facility/Intermediate Care Facility | 128 Cedar Ave, Waterbury, CT 06705-2700 | 2015-10-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598245037 | Karanbeer Singh Aulakh | Dentist | Smile & Shine Dental, 158 Manor Avenue, Waterbury, CT 06705 | 2018-08-15 |
| 1912495797 | Jennie Webb | Physician Assistant | 2247 E Main St Ste 103, Waterbury, CT 06705 | 2018-04-26 |
| 1558886671 | Macaela Cirish | Nurse Practitioner | 3801 East Main Street, Second Floor, Waterbury, CT 06705 | 2017-08-09 |
| 1033648464 | Mahwish Makhdoom | Pharmacist | 464 Reidville Drive, Waterbury, CT 06705 | 2017-06-08 |
| 1417407248 | Jaswinder Gulati | Dentist | 939 Wolcott Street Unit 5b, Waterbury, CT 06705 | 2016-10-05 |
| 1407272107 | Cori Capuano | Counselor | 230 Frost Rd Unit B, Waterbury, CT 06705 | 2014-03-05 |
| 1528403177 | Daniel G. Brennan | Dentist | 2457 East Main St, Waterbury, CT 06705 | 2013-05-08 |
| 1538419742 | Jenna Elizabeth Partola | Physician Assistant | 1327 Meriden Rd, Wolcott, CT 06705 | 2012-09-14 |
| 1710244785 | Mirta Sabino | Counselor | 126 Stonefield Dr, Waterbury, CT 06705 | 2012-04-16 |
| 1578849519 | Uday Shankar | Internal Medicine | 3801 E Main St Fl 2, Waterbury, CT 06705 | 2011-10-21 |
| Find all providers in zip 06705 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467072033 | Sarah Michelle Whalen | Nurse Practitioner | 100 Jefferson Sq, Waterbury, CT 06706-1109 | 2020-04-23 |
| 1720616246 | Susan Antoinette Pappas | Nurse Practitioner | 88 Grandview Ave, Waterbury, CT 06708-2509 | 2020-03-30 |
| 1578022166 | Daedly Potusek | Nurse Practitioner | 80 Phoenix Ave, Waterbury, CT 06702-1418 | 2019-03-14 |
| 1124592274 | Deon Johnson-allen | Nurse Practitioner | 88 Grandview Ave, Waterbury, CT 06708-2509 | 2019-01-11 |
| 1356818421 | Olanike Oyeyemi Idowu | Nurse Practitioner | 64 Robbins St, Waterbury, CT 06708-2613 | 2018-10-26 |
| 1104344506 | Kimberly Burns | Nurse Practitioner | 30 Holmes Ave, Waterbury, CT 06710-2412 | 2017-09-06 |
| 1407201957 | Alexandria Smith | Nurse Practitioner | 30 Holmes Ave, Waterbury, CT 06710-2412 | 2016-05-03 |
| 1134504715 | Nicholas James O'brien | Nurse Practitioner | 60 N Main St, 3rd Floor, Waterbury, CT 06702-1443 | 2015-07-24 |
| 1225461221 | Alyson Nicolosi | Nurse Practitioner | 80 Phoenix Ave, Suite 201, Waterbury, CT 06702-1418 | 2013-08-13 |
| 1780997601 | Barbara Kimble-goodman | Nurse Practitioner | 95 Thomaston Ave, Waterbury, CT 06702-1007 | 2010-07-20 |
| Find all providers in WATERBURY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.