MEDICARE: ESSENCE OF CHANEL HAIR AND BEAUTY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1104422211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSENCE OF CHANEL HAIR AND BEAUTY LLC

Provider Business Mailing Address
First Line	:	3000 MURRELL RD # 561272
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4431
Country	:	US
Telephone Number	:	321-914-9980
Fax Number	:

Provider Business Practice Location Address
First Line	:	2235 N COURTENAY PKWY UNIT 6
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-5213
Country	:	US
Telephone Number	:	321-914-9980
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AMBER BAKER
Credential	:	RN
Telephone Number	:	321-914-9980

Provider Enumeration Date	:	12/05/2020
Last Update Date	:	01/20/2026

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