Organization
BASS WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTIN WILLIAM SHAW NP-P, PMHNP-BC (CO-FOUNDER)
(917) 575-5662
Entity
Organization
Contact information
Practice address
1180 6TH AVE FL 8, NEW YORK, NY 10036-8401
(917) 923-0569
(469) 414-5292
Mailing address
263 FRANKLIN AVE APT 1B, BROOKLYN, NY 11205-3554
(917) 575-5662
(469) 414-5292
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/24/2022
Last updated
10/24/2022
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