Healthcare Provider Details

I. General information

NPI: 1750962742
Provider Name (Legal Business Name): ERIKA MONSHELLE GRANT HAIR LOSS SPECIALIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 59TH ST
BROOKLYN NY
11203-4810
US

IV. Provider business mailing address

100 E 59TH ST
BROOKLYN NY
11203-4810
US

V. Phone/Fax

Practice location:
  • Phone: 917-604-5044
  • Fax:
Mailing address:
  • Phone: 917-604-5044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: