MEDICARE: HEALTHY STRANDZ 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	174400000X	Specialist

General Provider Information

NPI Number	:	1831839943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY STRANDZ LLC

Provider Business Mailing Address
First Line	:	60 MEADOWGRASS DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033
Country	:	US
Telephone Number	:	314-283-8855
Fax Number	:

Provider Business Practice Location Address
First Line	:	4011 7 HILLS DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-6737
Country	:	US
Telephone Number	:	314-283-8855
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PAULETTA M BROOMFIELD
Credential	:
Telephone Number	:	314-283-8855

Provider Enumeration Date	:	03/29/2022
Last Update Date	:	03/29/2022

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Directions to “HEALTHY STRANDZ LLC ” Practice Location

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