MEDICARE: SHANEA BUIE CERTIFIED HAIR LOSS

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	224P00000X	Prosthetist
2	1744P3200X	Prosthetics Case Management

General Provider Information

NPI Number	:	1437765724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANEA BUIE CERTIFIED HAIR LOSS

Provider Business Mailing Address
First Line	:	1639 BRADLEY PARK DR STE 500
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-3623
Country	:	US
Telephone Number	:	706-393-1915
Fax Number	:

Provider Business Practice Location Address
First Line	:	5977 WHITESVILLE RD STE 20
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-3618
Country	:	US
Telephone Number	:	706-393-1915
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2020
Last Update Date	:	09/22/2020

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Directions to “ SHANEA BUIE CERTIFIED HAIR LOSS” Practice Location

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