Healthcare Provider Details

I. General information

NPI: 1134030141
Provider Name (Legal Business Name): MISS HAIR BEAUTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 KINGS GRANT WAY
WILMINGTON DE
19802-5248
US

IV. Provider business mailing address

1201 N ORANGE ST STE 7665
WILMINGTON DE
19801-1155
US

V. Phone/Fax

Practice location:
  • Phone: 484-821-6024
  • Fax:
Mailing address:
  • Phone: 484-821-6024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: SHATERA MILLER
Title or Position: OWNER
Credential: CPS
Phone: 484-821-6024