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Individual

SHADY TAVERAS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PMHNP

Contact information

Practice address
346 DAYTON RD, BRIDGEPORT, CT 06606-3112
(203) 450-6515
(959) 666-8678
Mailing address
346 DAYTON RD, BRIDGEPORT, CT 06606-3112
(203) 450-6515

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
14273
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
008023170
CT
05
008024427
CT
05
008042339
CT
Enumeration date
01/10/2014
Last updated
03/24/2025
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