South Shore Psychiatric Nurse Practitioner Group

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

SOUTH SHORE PSYCHIATRIC NURSE PRACTITIONER GROUP

Practice address

245 W Main St
Bay Shore, NY 11706-8323

Phone

(631) 771-7555

NPI assigned

Jul 17, 2020

Last updated

Jul 21, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tennille Braithwaite

Title

Office MGR

Phone

(631) 400-9251

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1594944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595289600000",
    "number": "1558979377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "154 CHICHESTER AVE",
            "city": "CENTER MORICHES",
            "state": "NY",
            "postal_code": "119342004",
            "telephone_number": "631-400-9251",
            "fax_number": "516-447-3403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 W MAIN ST",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117068323",
            "telephone_number": "631-771-7555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHORE PSYCHIATRIC NURSE PRACTITIONER GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-17",
        "last_updated": "2020-07-21",
        "certification_date": "2020-07-21",
        "status": "A",
        "authorized_official_last_name": "BRAITHWAITE",
        "authorized_official_first_name": "TENNILLE",
        "authorized_official_title_or_position": "OFFICE MGR",
        "authorized_official_telephone_number": "631-400-9251"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Bay Anesthes Assoc., LLP
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• South Shore Faculty Medical Affiliates, University Faculty Practice Co
• South Shore Infectious Diseases , PC
• South Shore SC, LLC
• South Shore Surgical Consulting PC
• South Shore University Hospital (Vivo Health Pharmacy at South Shore)
• South Shore University Hospital
• South Shore University Hospital

• Psychiatric/Mental Health Nurse Practitioner in Bay Shore, NY
• Providers in Bay Shore, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.