Provider Demographics
NPI:1215498522
Name:REINA, BRIGITTE SHEZELLE (MD)
Entity type:Individual
Prefix:
First Name:BRIGITTE
Middle Name:SHEZELLE
Last Name:REINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 W 6TH ST APT 11
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2538
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:583 S CLARIZZ BLVD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-5515
Practice Address - Country:US
Practice Address - Phone:812-676-4460
Practice Address - Fax:812-355-4092
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01094423A2084E0001X, 2084N0400X
ORMD2203512084N0008X
TXBP10082676390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program