Healthcare Provider Details

I. General information

NPI: 1659051647
Provider Name (Legal Business Name): SHORELINE MEDICAL ADDICTION TREATMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 W INDIAN RIVER BLVD STE 2
EDGEWATER FL
32132-3500
US

IV. Provider business mailing address

107 EAST CIR
NEW SMYRNA BEACH FL
32169-5213
US

V. Phone/Fax

Practice location:
  • Phone: 386-868-2619
  • Fax:
Mailing address:
  • Phone: 850-339-6808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN CHARLES VIEL
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 850-339-6808