Provider Demographics
NPI:1629794219
Name:SHIELD OF COLORS LLC
Entity Type:Organization
Organization Name:SHIELD OF COLORS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:IRVINM
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:407-967-2944
Mailing Address - Street 1:PO BOX 550866
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32855-0866
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:440 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-2559
Practice Address - Country:US
Practice Address - Phone:407-967-2944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier