MS. AMANDA SHACKELL APRN NPI 1295982429

NPI Information

NPI: 1295982429
Provider Name: MS. AMANDA SHACKELL, APRN
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

PECOS Registration: Yes

Address:
1 LONG WHARF DR
NEW HAVEN, CT
ZIP 06511
Phone: (203) 781-4600
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MS. Amanda Shackell, APRN is a psychiatric/mental health nurse practitioner in New Haven, CT with 26 years of experience. MS. Amanda Shackell, APRN NPI is 1295982429. 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:

1 LONG WHARF DR
NEW HAVEN, CT
ZIP 06511-991
Phone: (203) 781-4600
Fax: (203) 781-4624

The NPI 1295982429 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/19/2008 and was last updated on 1/24/2022.

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
1	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	002620	CONNECTICUT	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	004082286	MEDICAID	CONNECTICUT
2	004082260	MEDICAID	CONNECTICUT
3	004217099	MEDICAID	CONNECTICUT
4	008001325	MEDICAID	CONNECTICUT
5	008003745	MEDICAID	CONNECTICUT
6	008024427	MEDICAID	CONNECTICUT
7	500000315	MEDICAID	CONNECTICUT
8	C01033	OTHER	CONNECTICUT	MEDICARE IDENTIFICATION NUMBER
9	004041000	MEDICAID	CONNECTICUT
10	008023170	MEDICAID	CONNECTICUT
11	008042339	MEDICAID	CONNECTICUT
12	008037391	MEDICAID	CONNECTICUT
13	008022626	MEDICAID	CONNECTICUT
14	008022622	MEDICAID	CONNECTICUT
15	008039745	MEDICAID	CONNECTICUT

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: 4/28/2024

NPI Synchronization or Removal

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