Healthcare Provider Details

I. General information

NPI: 1427792928
Provider Name (Legal Business Name): BAYSIDE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1197 AIRPORT RD STE 2
MILFORD DE
19963-6491
US

IV. Provider business mailing address

73 GREENTREE DR # 335
DOVER DE
19904-7646
US

V. Phone/Fax

Practice location:
  • Phone: 302-508-0541
  • Fax: 302-202-5779
Mailing address:
  • Phone: 302-508-0541
  • Fax: 302-202-5779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EMILY HEISHMAN
Title or Position: OWNER
Credential: FNP-C, PMHNP-C
Phone: 302-508-0541