Reverse Time Wellness Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

REVERSE TIME WELLNESS INC

Practice address

1086 Long Ridge Rd
Stamford, CT 06903-4404

Phone

(203) 274-7426

Fax

(203) 274-7426

NPI assigned

Feb 13, 2025

Last updated

Apr 8, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Neishelle Walcott, PANPI 1447540901

Title

President

Phone

(203) 274-7426

Specialties & licenses 2

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Neishelle Dionne Walcott

  • Physician Assistant
  • Stamford, CT
  • NPI 1447540901
  NPD Authorized official
• Angelo Baccellieri, MD

  • Emergency Medicine Physician
  • Bronx, NY
  • NPI 1184794356
  NPD (past)
• Abel S Bencosme, PA

  • Physician Assistant
  • Bronx, NY
  • NPI 1831459197
  NPD (past)
• Lester Borrayes, NP

  • Family Nurse Practitioner
  • Bronx, NY
  • NPI 1417377672
  NPD (past)
• Vincent Costa, M.D.

  • Emergency Medicine Physician
  • Bronx, NY
  • NPI 1033538038
  NPD (past)
• Charrise McClellan, PMHNP

  • Psychiatry Physician
  • Brooklyn, NY
  • NPI 1437503786
  NPD (past)
• Robert H Meyer, MD

  • Emergency Medicine Physician
  • Bronx, NY
  • NPI 1063582245
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1739404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744070400000",
    "number": "1003611187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1086 LONG RIDGE RD",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069034404",
            "telephone_number": "203-274-7426",
            "fax_number": "203-274-7426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1086 LONG RIDGE RD",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069034404",
            "telephone_number": "203-274-7426",
            "fax_number": "203-274-7426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVERSE TIME WELLNESS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-13",
        "last_updated": "2025-04-08",
        "certification_date": "2025-04-08",
        "status": "A",
        "authorized_official_last_name": "WALCOTT",
        "authorized_official_first_name": "NEISHELLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-274-7426",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Michele Restaino, RPH, MPH
• Restoration Institute (Restorative Therapy)
• Retina Associates of CT
• Ernest Lee Retland III, M.D.
• Nancy Revangil, NANCY REVANGIL
• Kim Marie Reyes, M.D.
• Shanicka Reynolds, MD
• Yasaman Rezaie, MD
• RGB Incorporated (BrightStar Of Greenwich/Stamford)
• RGG Health LLC

• Family Medicine Physician in Stamford, CT
• Providers in Stamford, CT by specialty
• Family Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.