Provider Demographics
NPI:1497392542
Name:WELLS, CINDY (HAIR REPLACEMENT SPT)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:HAIR REPLACEMENT SPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 CLIFTON CT
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-3360
Mailing Address - Country:US
Mailing Address - Phone:757-593-5028
Mailing Address - Fax:
Practice Address - Street 1:604 ABERDEEN RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23661-1844
Practice Address - Country:US
Practice Address - Phone:757-593-5028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management