Healthcare Provider Details

I. General information

NPI: 1295667582
Provider Name (Legal Business Name): AURISYN BEAUTY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 HERRONS NEST PL NW STE 107
CONCORD NC
28027-3778
US

IV. Provider business mailing address

5818 HIGHLAND SHOPPES DR STE C5
CHARLOTTE NC
28269-2654
US

V. Phone/Fax

Practice location:
  • Phone: 980-946-4446
  • Fax:
Mailing address:
  • Phone:
  • 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: LANYCE OLDHAM
Title or Position: OWNER
Credential:
Phone: 202-285-7721