Provider Demographics
NPI:1477216349
Name:MORGAN, SHARONDA MONIQUE (CERTIFIED HAIRLOSS S)
Entity Type:Individual
Prefix:
First Name:SHARONDA
Middle Name:MONIQUE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:CERTIFIED HAIRLOSS S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 E RANCIER AVE STE 104A
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-7855
Mailing Address - Country:US
Mailing Address - Phone:254-415-7202
Mailing Address - Fax:
Practice Address - Street 1:3301 E RANCIER AVE STE 104A
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-7855
Practice Address - Country:US
Practice Address - Phone:254-415-7202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management