Provider Demographics
NPI:1356014146
Name:HER CRANIAL PROSTHETICS
Entity Type:Organization
Organization Name:HER CRANIAL PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAKEITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-743-4602
Mailing Address - Street 1:7810 DELANO RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1829
Mailing Address - Country:US
Mailing Address - Phone:202-400-9129
Mailing Address - Fax:202-217-2644
Practice Address - Street 1:6803 OLD ALEXANDRIA FERRY RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1744
Practice Address - Country:US
Practice Address - Phone:202-743-4602
Practice Address - Fax:202-217-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier