Provider Demographics
NPI:1114461050
Name:A FLASH OF HAIR
Entity Type:Organization
Organization Name:A FLASH OF HAIR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TESHA
Authorized Official - Middle Name:SHERELL
Authorized Official - Last Name:SEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-413-6813
Mailing Address - Street 1:10734 SPRINGFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-2008
Mailing Address - Country:US
Mailing Address - Phone:718-413-6813
Mailing Address - Fax:718-736-1746
Practice Address - Street 1:10734 SPRINGFIELD BLVD
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-2008
Practice Address - Country:US
Practice Address - Phone:718-413-6813
Practice Address - Fax:718-736-1746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier