Healthcare Provider Details

I. General information

NPI: 1497392542
Provider Name (Legal Business Name): CINDY WELLS HAIR REPLACEMENT SPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 ABERDEEN RD
HAMPTON VA
23661-1844
US

IV. Provider business mailing address

133 CLIFTON CT
NEWPORT NEWS VA
23608-3360
US

V. Phone/Fax

Practice location:
  • Phone: 757-593-5028
  • Fax:
Mailing address:
  • Phone: 757-593-5028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: