Provider Demographics
NPI:1013187574
Name:DEBBIE'S DAY SPA & SALON
Entity Type:Organization
Organization Name:DEBBIE'S DAY SPA & SALON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:THEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-825-0569
Mailing Address - Street 1:403 ANASTASIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-4508
Mailing Address - Country:US
Mailing Address - Phone:904-825-0569
Mailing Address - Fax:
Practice Address - Street 1:403 ANASTASIA BLVD
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-4508
Practice Address - Country:US
Practice Address - Phone:904-825-0569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM9360174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty