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SHORE TO SHORE MEDICAL WELLNESS PLLC
NPI 1679211965
Specialist in Port Jefferson Station, NY

Active since May 25, 2022
1500 ROUTE 112 STE B, PORT JEFFERSON STATION, NY 11776(631) 343-4184 Get Directions Write a Review

NPPES record last updated: February 17, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Feb 17, 2023, May 25, 2022 (2 updates tracked since 2022).

About Shore To Shore Medical Wellness Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHORE TO SHORE MEDICAL WELLNESS PLLC (NPI 1679211965) is a healthcare organization registered as a specialist in Port Jefferson Station, New York and active in the NPI registry since May 2022. The organization lists Gregory Brevetti, Owner, as its authorized official.

NPPES Registry Identity

NPI1679211965
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameSHORE TO SHORE MEDICAL WELLNESS PLLC
Location Address1500 ROUTE 112 STE BPort Jefferson Station, NY 11776-8055
Mailing Address1500 Route 112 Ste BPort Jefferson Station, NY 11776-8055
Phone(631) 343-4184
Organization SubpartNo
Authorized OfficialGregory BrevettiOwner · (917) 575-8907
Enumeration DateMay 25, 2022
Last NPPES UpdateFebruary 17, 20232 updates tracked since enumeration
NPPES CertifiedFebruary 17, 2023
✔ NPI 1679211965 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
1500 ROUTE 112 STE B, Port Jefferson Station, NY 11776
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANISH DESAI MD
Internal Medicine (Pulmonary Disease)
1500 ROUTE 112 STE B
PORT JEFFERSON STATION, NY 11776
Suffolk County (631) 978-7633
PETER OTTAVIO D.O.
Internal Medicine (Pulmonary Disease)
1500 ROUTE 112 STE B
PORT JEFFERSON STATION, NY 11776
Suffolk County (631) 978-7633
DR. KEITH WEBB HARRIS II DO
Internal Medicine (Pulmonary Disease)
1500 ROUTE 112 STE B
PORT JEFFERSON STATION, NY 11776
Suffolk County (631) 978-7633
DR. FRANCIS T. D'ORAZI III D.O.
Internal Medicine (Pulmonary Disease)
1500 ROUTE 112 STE B
PORT JEFFERSON STATION, NY 11776
Suffolk County (631) 978-7633
ISLANDWIDE THORACIC SURGERY, PLLC
Thoracic Surgery (Cardiothoracic Vascular Surgery)
1500 ROUTE 112 STE B
PORT JEFFERSON STATION, NY 11776
Suffolk County (631) 353-0909
YUVAL HILTZIK D.O.
Internal Medicine (Pulmonary Disease)
1500 ROUTE 112 STE B
PORT JEFFERSON STATION, NY 11776
Suffolk County (631) 978-7633
NORTHEASTERN THORACIC SURGERY, PLLC
Thoracic Surgery (Cardiothoracic Vascular Surgery)
1500 ROUTE 112 STE B
PORT JEFFERSON STATION, NY 11776
Suffolk County (631) 353-0909
DR. ANTHONY C THEODORIS M.D.
Internal Medicine (Pulmonary Disease)
1500 ROUTE 112 STE B
PORT JEFFERSON STATION, NY 11776
Suffolk County (631) 978-7633

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shore To Shore Medical Wellness PLLC's NPI number?

The NPI number for Shore To Shore Medical Wellness PLLC is 1679211965. It was assigned to this organization in the NPPES registry on May 25, 2022.

Where is Shore To Shore Medical Wellness PLLC located?

Shore To Shore Medical Wellness PLLC is located at 1500 Route 112 Ste B, Port Jefferson Station, NY 11776. The listed phone number is (631) 343-4184.

What is Shore To Shore Medical Wellness PLLC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

When was this NPI record last updated?

The NPPES record for Shore To Shore Medical Wellness PLLC was last updated on February 17, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.