Provider Demographics
NPI:1295382158
Name:JONES-MCQUEEN, SADEQUA (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:MRS
First Name:SADEQUA
Middle Name:
Last Name:JONES-MCQUEEN
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 BRITTON CT
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-7309
Mailing Address - Country:US
Mailing Address - Phone:919-798-4529
Mailing Address - Fax:
Practice Address - Street 1:601 BRITTON CT
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-7309
Practice Address - Country:US
Practice Address - Phone:919-798-4529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC84039224P00000X, 1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty