Provider Demographics
NPI:1699378455
Name:AIYEGBUSI, JANET RANTI (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:RANTI
Last Name:AIYEGBUSI
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 FRENSHAM CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2855
Mailing Address - Country:US
Mailing Address - Phone:202-907-5998
Mailing Address - Fax:
Practice Address - Street 1:9171 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-3837
Practice Address - Country:US
Practice Address - Phone:301-627-3707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4204531744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty