=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790632776
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHORE PSYCHIATRIC SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2026
-----------------------------------------------------
Last Update Date | 03/11/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14955 GREENSBORO RD
-----------------------------------------------------
City | GOLDSBORO
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21636-1311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-656-1541
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14955 GREENSBORO RD
-----------------------------------------------------
City | GOLDSBORO
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21636-1311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-924-7360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TAMMY LYNN MERSON
-----------------------------------------------------
Credential | MSN, PMHNP-BC
-----------------------------------------------------
Telephone | 410-924-7360
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------