Shaka Reynolds

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

093362 Issued in NY

Practice address

119 W 124TH St
New York, NY 10027-4920

Phone

(212) 932-2810

NPI assigned

Jul 9, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1531094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737331200000",
    "number": "1164918561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 W 124TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100274920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 W 124TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100274920",
            "telephone_number": "212-932-2810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "SHAKA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-09",
        "last_updated": "2025-01-20",
        "certification_date": "2025-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "102393",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "093362",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Reynolds, NURSE PRACTITIONER
• Nicole Noelle Reynolds, NP
• Olecia Reynolds, MD
• Quentin Joseph Reynolds, MD
• Sarah Reynolds
• Ana A Reynoso- Miranda
• Enrique Reynoso
• Genill Reynoso, FNP-BC
• Joseph Reynoso
• Julissa Reynoso

• Clinical Social Worker in New York, NY
• Providers in New York, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.