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General NPI Number Information
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NPI Number | 1427792928
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Entity Type | Organization
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Legal Business Name | BAYSIDE WELLNESS LLC
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Dates
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Enumeration Date | 04/21/2022
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 1197 AIRPORT RD STE 2
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City | MILFORD
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State | DE
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Zip | 19963-6491
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Country | US
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Telephone | 302-508-0541
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Fax | 302-202-5779
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Provider Business Mailing Address
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Address Line | 73 GREENTREE DR # 335
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City | DOVER
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State | DE
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Zip | 19904-7646
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Country | US
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Telephone | 302-508-0541
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Fax | 302-202-5779
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Authorized Official
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Title or Position | OWNER
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Name | EMILY HEISHMAN
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Credential | FNP-C, PMHNP-C
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Telephone | 302-508-0541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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