# SOUTH SHORE PSYCHIATRIC NURSE PRACTITIONER GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558979377
- **Authorized official:** TENNILLE BRAITHWAITE (OFFICE MGR)
- **Authorized official phone:** (631) 400-9251

## Contact information

- **Practice address:** 245 W MAIN ST, BAY SHORE, NY 11706-8323
- **Practice address phone:** (631) 771-7555
- **Mailing address:** 154 CHICHESTER AVE, CENTER MORICHES, NY 11934-2004
- **Mailing address phone:** (631) 400-9251
- **Mailing address fax:** (516) 447-3403

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 07/17/2020
- **Last updated:** 07/21/2020