Provider Demographics
NPI:1043604366
Name:CUTTUPNDYED
Entity Type:Organization
Organization Name:CUTTUPNDYED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSIA
Authorized Official - Middle Name:CASSANDRA
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED HAIR LOSS
Authorized Official - Phone:443-453-7889
Mailing Address - Street 1:14110 BURWELLS BAY RD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-3711
Mailing Address - Country:US
Mailing Address - Phone:443-453-7889
Mailing Address - Fax:
Practice Address - Street 1:14110 BURWELLS BAY RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-3711
Practice Address - Country:US
Practice Address - Phone:443-453-7889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty