Healthcare Provider Details

I. General information

NPI: 1730025297
Provider Name (Legal Business Name): CRANIAL CRUSH & CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 CORNELIA CT
ORLANDO FL
32811-4340
US

IV. Provider business mailing address

641 CORNELIA CT
ORLANDO FL
32811-4340
US

V. Phone/Fax

Practice location:
  • Phone: 689-307-6771
  • Fax:
Mailing address:
  • Phone: 689-307-6771
  • 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: JANIYA FRAZIER
Title or Position: OWNER
Credential:
Phone: 689-307-6771