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General NPI Number Information
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NPI Number | 1982560066
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Entity Type | Organization
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Legal Business Name | SHOP BEAUTY BAR LLC
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Dates
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Enumeration Date | 01/01/2026
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Last Update Date | 01/01/2026
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Provider Practice Location Address
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Address Line | 18802A LIBERTY AVE
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City | SAINT ALBANS
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State | NY
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Zip | 11412-1049
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Country | US
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Telephone | 929-385-5989
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Fax | 205-751-9233
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Provider Business Mailing Address
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Address Line | 21907 143RD RD
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City | LAURELTON
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State | NY
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Zip | 11413-3114
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Country | US
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Telephone | 929-385-5989
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Fax | 205-751-9233
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Authorized Official
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Title or Position | OWNER
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Name | MS. SHANTELL E JAY
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Credential |
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Telephone | 929-385-5989
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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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