MEDICARE: MS. KAYON SHEPHERD HAIR REPLACEMENT TE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier
2	224P00000X	Prosthetist	FL
3	174400000X	Specialist
4	224P00000X	Prosthetist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	47-2338905	OTHER	FL

General Provider Information

NPI Number	:	1992274252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAYON SHEPHERD HAIR REPLACEMENT TE

Provider Business Mailing Address
First Line	:	6250 CYPRESS GARDENS BLVD STE 27
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-3177
Country	:	US
Telephone Number	:	954-951-4310
Fax Number	:

Provider Business Practice Location Address
First Line	:	6250 CYPRESS GARDENS BLVD STE 27
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-3177
Country	:	US
Telephone Number	:	954-951-4310
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2018
Last Update Date	:	01/16/2026

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