Healthcare Provider Details

I. General information

NPI: 1043120215
Provider Name (Legal Business Name): SKINIQUE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11709 FRUEHAUF DR STE 222
CHARLOTTE NC
28273-0043
US

IV. Provider business mailing address

12924 LAKE ERIE LN
CHARLOTTE NC
28273-7145
US

V. Phone/Fax

Practice location:
  • Phone: 704-904-7898
  • Fax:
Mailing address:
  • Phone: 704-904-7898
  • 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: REGJINIQUE HARRIS
Title or Position: OWNER
Credential: BS,LE
Phone: 704-904-7898