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
—
—
Other
Enumeration date
07/17/2020
Last updated
07/21/2020
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