Provider Demographics
NPI:1679363097
Name:CK WELLNESS LLC
Entity type:Organization
Organization Name:CK WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRNETT
Authorized Official - Middle Name:KHORRAN
Authorized Official - Last Name:GAJARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:NP-PMH
Authorized Official - Phone:339-793-9080
Mailing Address - Street 1:729 BRIDGE ST
Mailing Address - Street 2:STE 1 PMB 1046
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02191-2135
Mailing Address - Country:US
Mailing Address - Phone:339-793-9080
Mailing Address - Fax:
Practice Address - Street 1:529 PEARL STREET
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:339-793-9080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty