Shorewellness and Med Spa, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

SHOREWELLNESS AND MED SPA, LLC

Practice address

11200 Racetrack Rd Ste A104
Berlin, MD 21811-3809

Phone

(410) 973-1030

Fax

(410) 973-1029

NPI assigned

Apr 15, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

William Edward Gunn, MD

Title

Owner

Phone

(410) 973-1030

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586908800000",
    "number": "1104445535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11200 RACETRACK RD STE A104",
            "city": "BERLIN",
            "state": "MD",
            "postal_code": "218113809",
            "telephone_number": "410-973-1030",
            "fax_number": "410-973-1029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11200 RACETRACK RD STE A104",
            "city": "BERLIN",
            "state": "MD",
            "postal_code": "218113809",
            "telephone_number": "410-973-1030",
            "fax_number": "410-973-1029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOREWELLNESS AND MED SPA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-15",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "status": "A",
        "authorized_official_last_name": "GUNN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-973-1030",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alyssa Sherr
• Ralph Sherwood, PT
• Shore Regional Eye Care, LLC
• Shore Therapy Solutions, LLC
• Shoreline Wellness and Primary Care LLC
• Gary Short, PT
• Alexa Lynn Yetta Shoultes, LCSW-C
• Roxanne Suzette Shuman, LGSW
• Chandler Littleton Siers
• Angela Marie Simmons, C.R.N.P.

• Primary Care Clinic/Center in Berlin, MD
• Providers in Berlin, MD by specialty
• Primary Care Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.