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General NPI Number Information
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NPI Number | 1730834771
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Entity Type | Organization
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Legal Business Name | SASSY SISTAS BOUTIQUE LLC
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Dates
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Enumeration Date | 02/17/2022
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 851 W STATE ROAD 436 STE 1005
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-3055
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Country | US
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Telephone | 407-383-0643
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Fax |
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Provider Business Mailing Address
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Address Line | 851 W STATE ROAD 436 STE 1005
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-3055
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Country | US
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Telephone | 407-383-0643
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. EBONI RAINEY-HAYNES
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Credential |
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Telephone | 407-383-0643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State |
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Taxonomy #2
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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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