Healthcare Provider Details

I. General information

NPI: 1790307767
Provider Name (Legal Business Name): JYMESHA YAPELLE BEAUTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BAPTIST ST STE 109
SALISBURY MD
21801-4932
US

IV. Provider business mailing address

2636 N SALISBURY BLVD # 1032
SALISBURY MD
21801-2141
US

V. Phone/Fax

Practice location:
  • Phone: 443-978-2728
  • Fax:
Mailing address:
  • Phone: 443-978-2728
  • Fax:

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 TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MS. JYMESHA TRUITT
Title or Position: COORDINATOR
Credential:
Phone: 443-978-2728