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MASHANTUCKET PEQUOT TRIBAL COUNCIL
NPI 1508140922
Family Medicine in Ledyard, CT

Active since October 04, 2011CLIA 07D0968602 · Waiver
75 ROUTE 2, LEDYARD, CT 06339(860) 312-8000(860) 312-8001 Get Directions Write a Review

NPPES record last updated: May 16, 2014. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Mashantucket Pequot Tribal Council NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MASHANTUCKET PEQUOT TRIBAL COUNCIL (NPI 1508140922) is a healthcare organization registered as a family medicine in Ledyard, Connecticut and active in the NPI registry since October 2011. The organization holds a CLIA Waiver certificate valid through December 15, 2027 and lists Shanna Tari Reels, Tribal Health Services Director, as its authorized official.

NPPES Registry Identity

NPI1508140922
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameMASHANTUCKET PEQUOT TRIBAL COUNCIL
Location Address75 ROUTE 2Ledyard, CT 06339-1128
Mailing AddressPo Box 3260, 75 Rt 2Mashantucket, CT 06339-3260 · (860) 312-8000 · Fax (860) 312-8001
Phone(860) 312-8000
Fax(860) 312-8001
Organization SubpartNo
Authorized OfficialShanna Tari ReelsTribal Health Services Director · (860) 312-8014
Enumeration DateOctober 4, 2011
Last NPPES UpdateMay 16, 2014
✔ NPI 1508140922 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

75 ROUTE 2, Ledyard, CT 06339
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 07D0968602

Mashantucket Pequot Tribal Health Dept · Ledyard, CT
Active · expires Dec 15, 2027
CLIA Number07D0968602
Laboratory TypeRural Health Clinic
Certificate Effective DateDecember 16, 2025
Certificate Expiration DateDecember 15, 2027
Laboratory DirectorSetu Vora
Laboratory Phone(860) 312-8000
Laboratory LocationMashantucket Pequot Tribal Health Dept75 Route 2, Ledyard, CT 06339
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. SANDRA BERARDY AP RN
Clinical Nurse Specialist (Community Health/Public Health)
75 ROUTE 2, MASHANTUCKET PEQUOT INDIAN HEALTH SERVICES
LEDYARD, CT 06339
Southeastern Connecticut Planning Region (860) 312-8000
DR. PATRICIA A DUBOSE M.D.
Internal Medicine (Infectious Disease)
75 ROUTE 2
LEDYARD, CT 06339
Southeastern Connecticut Planning Region (860) 312-8000
MASHANTUCKET PEQUOT TRIBAL NATION HEALTH CENTER
Clinic/Center
75 ROUTE 2
LEDYARD, CT 06339
Southeastern Connecticut Planning Region (860) 321-8000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mashantucket Pequot Tribal Council's NPI number?

The NPI number for Mashantucket Pequot Tribal Council is 1508140922. It was assigned to this organization in the NPPES registry on October 4, 2011.

Where is Mashantucket Pequot Tribal Council located?

Mashantucket Pequot Tribal Council is located at 75 Route 2, Ledyard, CT 06339. The listed phone number is (860) 312-8000.

What is Mashantucket Pequot Tribal Council's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Mashantucket Pequot Tribal Council hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 07D0968602) is associated with this NPI, valid through December 15, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Mashantucket Pequot Tribal Council was last updated on May 16, 2014. NPI Profile syncs with the weekly NPPES data releases published by CMS.