Healthcare Provider Details

I. General information

NPI: 1700795135
Provider Name (Legal Business Name): BAYSIDE HEALTH HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 FRANKLIN AVE UNIT 14
BERLIN MD
21811-1358
US

IV. Provider business mailing address

617 FRANKLIN AVE UNIT 14
BERLIN MD
21811-1358
US

V. Phone/Fax

Practice location:
  • Phone: 443-373-3245
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHANNON SMITH
Title or Position: MANAGING MEMBER
Credential: NP
Phone: 443-373-3245