Healthcare Provider Details

I. General information

NPI: 1104735851
Provider Name (Legal Business Name): STRAIGHTEN YOUR CROWN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 HARWAY DR
ROCHESTER NY
14625-2641
US

IV. Provider business mailing address

16 HARWAY DR
ROCHESTER NY
14625-2641
US

V. Phone/Fax

Practice location:
  • Phone: 585-795-6198
  • Fax:
Mailing address:
  • Phone: 585-795-6198
  • 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: SHENNETTA S WILSON
Title or Position: CRANIAL PROSTHESIS SPECIALIST
Credential:
Phone: 585-606-9612