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General NPI Number Information
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NPI Number | 1700795135
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Entity Type | Organization
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Legal Business Name | BAYSIDE HEALTH HOLDINGS LLC
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Dates
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Enumeration Date | 09/02/2026
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Last Update Date | 09/02/2026
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Provider Practice Location Address
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Address Line | 617 FRANKLIN AVE UNIT 14
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City | BERLIN
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State | MD
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Zip | 21811-1358
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Country | US
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Telephone | 443-373-3245
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Fax |
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Provider Business Mailing Address
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Address Line | 617 FRANKLIN AVE UNIT 14
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City | BERLIN
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State | MD
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Zip | 21811-1358
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | SHANNON SMITH
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Credential | NP
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Telephone | 443-373-3245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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