# NY SHORELINE MEDICAL SERVICES PLLC

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

## Provider details

- **NPI number:** 1992661359
- **Authorized official:** GREGORY BREVETTI MD (OWNER)
- **Authorized official phone:** (917) 575-8907

## Contact information

- **Practice address:** 4875 SUNRISE HWY STE 302, BOHEMIA, NY 11716-4630
- **Practice address phone:** (917) 575-8907
- **Mailing address:** 4875 SUNRISE HWY STE 302, BOHEMIA, NY 11716-4630
- **Mailing address phone:** (631) 942-0745

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | — | NULL | Yes |
| 363AS0400X | Surgical Physician Assistant | — | — | Yes |

## Other

- **Enumeration date:** 12/30/2025
- **Last updated:** 12/30/2025