Provider Demographics
NPI:1083254460
Name:CONFIDENTLY CROWNED LLC
Entity Type:Organization
Organization Name:CONFIDENTLY CROWNED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLA
Authorized Official - Middle Name:KATTY
Authorized Official - Last Name:CHARLOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-914-4451
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-0489
Mailing Address - Country:US
Mailing Address - Phone:407-914-4451
Mailing Address - Fax:888-588-1831
Practice Address - Street 1:4270 ALOMA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-9424
Practice Address - Country:US
Practice Address - Phone:407-906-4738
Practice Address - Fax:888-588-1831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment