Provider Demographics
NPI:1407621329
Name:SHANNA HAIR BAR
Entity Type:Organization
Organization Name:SHANNA HAIR BAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNA KAY
Authorized Official - Middle Name:DIANDRA
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-776-6746
Mailing Address - Street 1:9625 SURVEYOR CT STE 110
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4408
Mailing Address - Country:US
Mailing Address - Phone:571-776-6746
Mailing Address - Fax:
Practice Address - Street 1:9625 SURVEYOR CT STE 110
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4408
Practice Address - Country:US
Practice Address - Phone:571-776-6746
Practice Address - Fax:276-332-8969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier