Provider Demographics
NPI:1710695028
Name:BOYD, NYDISHA (COSMETOLOGIST)
Entity Type:Individual
Prefix:
First Name:NYDISHA
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:COSMETOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3343 PIETRO WAY
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-5541
Mailing Address - Country:US
Mailing Address - Phone:267-253-7053
Mailing Address - Fax:
Practice Address - Street 1:29 S 60TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3004
Practice Address - Country:US
Practice Address - Phone:215-921-2410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist