MEDICARE: QUEONTAY SHERITA WARD COSMETOLOGIST

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	96136	SC

General Provider Information

NPI Number	:	1881559839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUEONTAY SHERITA WARD COSMETOLOGIST

Provider Business Mailing Address
First Line	:	2630 OTRANTO RD APT E11
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9683
Country	:	US
Telephone Number	:	843-940-0928
Fax Number	:

Provider Business Practice Location Address
First Line	:	2630 OTRANTO RD APT E11
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9683
Country	:	US
Telephone Number	:	843-940-0928
Fax Number	:

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

Provider Enumeration Date	:	12/22/2025
Last Update Date	:	12/22/2025

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