Provider Demographics
NPI:1689333668
Name:ANDERSON, PERRIN DEANDRE (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:
First Name:PERRIN
Middle Name:DEANDRE
Last Name:ANDERSON
Suffix:
Gender:M
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 1:831 TRAVERS ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-6908
Mailing Address - Country:US
Mailing Address - Phone:803-664-8180
Mailing Address - Fax:
Practice Address - Street 1:831 TRAVERS ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-6908
Practice Address - Country:US
Practice Address - Phone:803-664-8180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management