Healthcare Provider Details

I. General information

NPI: 1134735905
Provider Name (Legal Business Name): BAY MEDICAL & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 07/24/2021
Certification Date: 07/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13794 TIDEWATER TRL
SALUDA VA
23149-2314
US

IV. Provider business mailing address

PO BOX 95
HARTFIELD VA
23071-0095
US

V. Phone/Fax

Practice location:
  • Phone: 804-586-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHANNON LEE STONE
Title or Position: FAMILY NURSE PRACTITIONER/OWNER
Credential: NP
Phone: 804-286-9377