Healthcare Provider Details

I. General information

NPI: 1790628014
Provider Name (Legal Business Name): MESSIAH CRANIAL PROSTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2026
Last Update Date: 04/11/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14261 SW 120TH ST STE 108-800
MIAMI FL
33186-7270
US

IV. Provider business mailing address

14261 SW 120TH ST STE 108-800
MIAMI FL
33186-7270
US

V. Phone/Fax

Practice location:
  • Phone: 888-370-0744
  • Fax:
Mailing address:
  • Phone: 888-370-0744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: SHATERRA BURTON
Title or Position: CRANIAL PROSTHETICS
Credential: CPS
Phone: 888-370-0744