Healthcare Provider Details

I. General information

NPI: 1689595167
Provider Name (Legal Business Name): SHORE GROWTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 SEWARD DR
OCEAN NJ
07712-3744
US

IV. Provider business mailing address

29 SEWARD DR
OCEAN NJ
07712-3744
US

V. Phone/Fax

Practice location:
  • Phone: 908-309-6948
  • Fax:
Mailing address:
  • Phone: 908-309-6948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHARON DIAZ-HARVEY
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 908-309-4230