MRS. SHANTELLE BROKAW NPI 1114462561

NPI Information

  • NPI: 1114462561
  • Provider Name: MRS. SHANTELLE BROKAW
  • Classification: Nurse Practitioner - 363LP0808X
  • Specialization: Psychiatric/Mental Health
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 128 CEDAR AVE
    WATERBURY, CT
    ZIP 06705
  • Phone: (203) 757-9271

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NPI Details

MRS. Shantelle Brokaw is a psychiatric/mental health nurse practitioner in Waterbury, CT. MRS. Shantelle Brokaw NPI is 1114462561. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

128 CEDAR AVE
WATERBURY, CT
ZIP 06705-700
Phone: (203) 757-9271

The NPI 1114462561 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Follow-up nursing facility visit per day, typically 25 minutes (HCPCS:99309)
  • Follow-up nursing facility visit per day, typically 15 minutes (HCPCS:99308)
  • Psychotherapy with evaluation and management visit, 30 minutes (HCPCS:90833)

The enumeration date for this NPI number is 12/21/2016 and was last updated on 4/14/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LP0808XNurse PractitionerPsychiatric/Mental Health6831CONNECTICUTYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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