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General NPI Number Information
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NPI Number | 1356014146
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Entity Type | Organization
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Legal Business Name | HER CRANIAL PROSTHETICS
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Dates
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Enumeration Date | 07/27/2021
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Last Update Date | 07/27/2021
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Provider Practice Location Address
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Address Line | 6803 OLD ALEXANDRIA FERRY RD
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City | CLINTON
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State | MD
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Zip | 20735-1744
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Country | US
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Telephone | 202-743-4602
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Fax | 202-217-2644
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Provider Business Mailing Address
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Address Line | 7810 DELANO RD
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City | CLINTON
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State | MD
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Zip | 20735-1829
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Country | US
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Telephone | 202-400-9129
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Fax | 202-217-2644
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHAKEITA BOYD
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Credential |
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Telephone | 202-743-4602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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