Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Shore to Shore Medical Wellness PLLC

Organization Specialist · NPI 1679211965

Shore to Shore Medical Wellness PLLC is a Specialist in Port Jefferson Station, New York. Registered with an NPI since 2022.

In the registry since
2022
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1500 Route 112 Ste B
Port Jefferson Station, NY 11776-8055
Phone: (631) 343-4184
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X

Record details

NPI number1679211965
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Gregory Brevetti — Owner · (917) 575-8907
NPI enumeratedMay 25, 2022
Last updated in NPPESFebruary 17, 2023
Certification dateFebruary 17, 2023
Mailing address1500 Route 112 Ste B, Port Jefferson Station, NY 11776-8055

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