Provider Demographics
NPI:1437765724
Name:BUIE, SHANEA (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:
First Name:SHANEA
Middle Name:
Last Name:BUIE
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1639 BRADLEY PARK DR STE 500
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-3623
Mailing Address - Country:US
Mailing Address - Phone:706-393-1915
Mailing Address - Fax:
Practice Address - Street 1:5977 WHITESVILLE RD STE 20
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3618
Practice Address - Country:US
Practice Address - Phone:706-393-1915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist