MEDICARE: DIVA HAIR BLESSINGS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224P00000X	Prosthetist

General Provider Information

NPI Number	:	1992443071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVA HAIR BLESSINGS

Provider Business Mailing Address
First Line	:	608 CEDAR RD
Second Line	:	SUITE 102
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-6603
Country	:	US
Telephone Number	:	301-893-7213
Fax Number	:

Provider Business Practice Location Address
First Line	:	608 CEDAR RD
Second Line	:	SUITE 102
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-6603
Country	:	US
Telephone Number	:	301-893-7213
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	SAUNDRA E JACKSON
Credential	:
Telephone Number	:	301-893-7213

Provider Enumeration Date	:	05/26/2022
Last Update Date	:	01/26/2023

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Directions to “DIVA HAIR BLESSINGS ” Practice Location

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