Active NPI
Amanda Shackell, APRN
- Psychiatric/Mental Health Nurse Practitioner
- New Haven, CT
National Provider Identifier
1295982429
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- 002620
- Practice address
- 1 Long Wharf Dr
New Haven, CT 06511-5991 - Phone
- (203) 781-4600
- Fax
- (203) 781-4624
- NPI assigned
- Aug 19, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 002620 | CT | Primary |
Addresses
Primary practice location
1 Long Wharf Dr
New Haven, CT 06511-5991
Mailing address
1 Long Wharf Dr
Ste 321
New Haven, CT 06511-5991
Phone (203) 781-4600
Other identifiers 15
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004217099 | Medicaid | CT | |
| 008023170 | Medicaid | CT | |
| 004082286 | Medicaid | CT | |
| 008024427 | Medicaid | CT | |
| 008003745 | Medicaid | CT | |
| 008022622 | Medicaid | CT | |
| 008037391 | Medicaid | CT | |
| 008039745 | Medicaid | CT | |
| 500000315 | Medicaid | CT | |
| C01033 | Other | CT | MEDICARE IDENTIFICATION NUMBER |
| 008022626 | Medicaid | CT | |
| 004041000 | Medicaid | CT | |
| 004082260 | Medicaid | CT | |
| 008001325 | Medicaid | CT | |
| 008042339 | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002620 | CT | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642982400000",
"number": "1295982429",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 LONG WHARF DR",
"address_2": "STE 321",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065115991",
"telephone_number": "203-781-4600",
"fax_number": "203-781-4624"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 LONG WHARF DR",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065115991",
"telephone_number": "203-781-4600",
"fax_number": "203-781-4624"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHACKELL",
"first_name": "AMANDA",
"name_prefix": "Ms.",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-08-19",
"last_updated": "2022-01-24",
"certification_date": "2022-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "CT",
"license": "002620",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004217099",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008023170",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004082286",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008024427",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008003745",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008022622",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008037391",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008039745",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500000315",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE IDENTIFICATION NUMBER",
"identifier": "C01033",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008022626",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004041000",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004082260",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008001325",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008042339",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in New Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.