Provider Demographics
NPI:1164280111
Name:REID, COLLISHA (RN)
Entity Type:Individual
Prefix:
First Name:COLLISHA
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:COLLISHA
Other - Middle Name:
Other - Last Name:REID-PHILIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:53 BELMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07727-3667
Mailing Address - Country:US
Mailing Address - Phone:201-421-1706
Mailing Address - Fax:
Practice Address - Street 1:53 BELMAR BLVD
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NJ
Practice Address - Zip Code:07727-3667
Practice Address - Country:US
Practice Address - Phone:201-421-1706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY836019163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health