Provider Demographics
NPI:1336832476
Name:BAYSIDE MENTAL HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:BAYSIDE MENTAL HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CHUI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:727-304-1115
Mailing Address - Street 1:1727 COACHMAN PLAZA DR STE 215
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-1932
Mailing Address - Country:US
Mailing Address - Phone:727-304-1115
Mailing Address - Fax:
Practice Address - Street 1:1727 COACHMAN PLAZA DR STE 215
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1932
Practice Address - Country:US
Practice Address - Phone:727-304-1115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty