Individual
MRS. SHANTELLE BROKAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
128 CEDAR AVE, WATERBURY, CT 06705-2700
(203) 757-9271
Mailing address
500 ALBANY AVE, HARTFORD, CT 06120-2508
(860) 249-9625
(860) 808-1580
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
6831
CT
Other
Enumeration date
12/21/2016
Last updated
04/14/2020
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