Provider Demographics
NPI:1427792928
Name:BAYSIDE WELLNESS LLC
Entity type:Organization
Organization Name:BAYSIDE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C, PMHNP-C
Authorized Official - Phone:302-508-0541
Mailing Address - Street 1:73 GREENTREE DR # 335
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-7646
Mailing Address - Country:US
Mailing Address - Phone:302-508-0541
Mailing Address - Fax:302-202-5779
Practice Address - Street 1:1197 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-6491
Practice Address - Country:US
Practice Address - Phone:302-508-0541
Practice Address - Fax:302-202-5779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-21
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty