Provider Demographics
NPI:1376244707
Name:SHORELINE WELLNESS AND PRIMARY CARE LLC
Entity Type:Organization
Organization Name:SHORELINE WELLNESS AND PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:757-990-1031
Mailing Address - Street 1:314 FRANKLIN AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1238
Mailing Address - Country:US
Mailing Address - Phone:410-513-4046
Mailing Address - Fax:
Practice Address - Street 1:314 FRANKLIN AVE STE 301
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1238
Practice Address - Country:US
Practice Address - Phone:410-513-4046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty