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Organization
SOUTH SHORE PSYCHIATRIC NURSE PRACTITIONER GROUP
Active
Organization
SOUTH SHORE PSYCHIATRIC NURSE PRACTITIONER GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TENNILLE BRAITHWAITE (OFFICE MGR)
(631) 400-9251
Entity
Organization
Contact information
Practice address
245 W MAIN ST, BAY SHORE, NY 11706-8323
(631) 771-7555
Mailing address
154 CHICHESTER AVE, CENTER MORICHES, NY 11934-2004
(631) 400-9251
(516) 447-3403
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
07/17/2020
Last updated
07/21/2020
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