Provider Demographics
NPI:1740801695
Name:UNIFIED PROSTHETICS AND ORTHOTICS, LLC.
Entity Type:Organization
Organization Name:UNIFIED PROSTHETICS AND ORTHOTICS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHYKEDRA
Authorized Official - Middle Name:DENIECE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:769-257-6197
Mailing Address - Street 1:506 GRANTS FERRY RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-9076
Mailing Address - Country:US
Mailing Address - Phone:769-257-6197
Mailing Address - Fax:769-216-2524
Practice Address - Street 1:506 GRANTS FERRY RD STE 102
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-9076
Practice Address - Country:US
Practice Address - Phone:769-257-6197
Practice Address - Fax:769-216-2524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-01
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier