Healthcare Provider Details

I. General information

NPI: 1063106813
Provider Name (Legal Business Name): EPIC LOOKS HAIR AND WIGS COLLECTION LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7837 W SAMPLE RD STE 127
CORAL SPRINGS FL
33065-4751
US

IV. Provider business mailing address

7837 W SAMPLE RD STE 127
CORAL SPRINGS FL
33065-4751
US

V. Phone/Fax

Practice location:
  • Phone: 954-951-4310
  • Fax: 205-878-9620
Mailing address:
  • Phone: 954-951-4310
  • Fax: 205-878-9620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: KAYON SHEPHERD
Title or Position: CRANIAL PROSTHESIS
Credential:
Phone: 954-951-4310