Individual
MS. AMANDA SHACKELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1 LONG WHARF DR, NEW HAVEN, CT 06511-5991
(203) 781-4600
(203) 781-4624
Mailing address
1 LONG WHARF DR, STE 321, NEW HAVEN, CT 06511-5991
(203) 781-4600
(203) 781-4624
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
002620
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004041000
—
CT
05
—
004082260
—
CT
05
—
004082286
—
CT
05
—
004217099
—
CT
05
—
008001325
—
CT
05
—
008003745
—
CT
05
—
008022622
—
CT
05
—
008022626
—
CT
05
—
008023170
—
CT
05
—
008024427
—
CT
05
—
008037391
—
CT
05
—
008039745
—
CT
05
—
008042339
—
CT
05
—
500000315
—
CT
01
—
C01033
MEDICARE IDENTIFICATION NUMBER
CT
Enumeration date
08/19/2008
Last updated
01/24/2022
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