Healthcare Provider Details

I. General information

NPI: 1093533051
Provider Name (Legal Business Name): SHEAR PASSION HAIR STUDIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 W MARKET ST
GREENSBORO NC
27401-1811
US

IV. Provider business mailing address

710 W MARKET ST
GREENSBORO NC
27401-1811
US

V. Phone/Fax

Practice location:
  • Phone: 336-617-6312
  • Fax:
Mailing address:
  • Phone: 336-617-6312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. LATONYA G LEWIS-TUNSIL
Title or Position: MASTER COSMETOLOGIST
Credential: HAIRLOSS PRACTITIONE
Phone: 336-405-7101