Healthcare Provider Details

I. General information

NPI: 1740150507
Provider Name (Legal Business Name): SKIN INVY HYDRATION AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10130 MALLARD CREEK RD STE 310
CHARLOTTE NC
28262-6001
US

IV. Provider business mailing address

10421 KEMPSFORD DR
CHARLOTTE NC
28262-2718
US

V. Phone/Fax

Practice location:
  • Phone: 980-406-0185
  • Fax:
Mailing address:
  • Phone: 980-433-0517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. VANESSA MARIE MADDEN-GILYARD
Title or Position: OWNER/CEO
Credential: NP
Phone: 980-433-0517