Provider Demographics
NPI:1962507798
Name:REEDER, SHAHDOKHT (PMHNP)
Entity Type:Individual
Prefix:
First Name:SHAHDOKHT
Middle Name:
Last Name:REEDER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 414628
Mailing Address - Street 2:PHYSICIANS ACCOUNTS RECEIVABLE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-4628
Mailing Address - Country:US
Mailing Address - Phone:127-449-6150
Mailing Address - Fax:
Practice Address - Street 1:2014 WASHINGTON ST
Practice Address - Street 2:NEWTON WELLESLEY HOSPITAL
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1607
Practice Address - Country:US
Practice Address - Phone:617-243-6298
Practice Address - Fax:617-243-6184
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ229433367500000X
MARN226028367500000X
MA226028363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANA1131Medicare ID - Type Unspecified