Provider Demographics
NPI:1770831463
Name:GUILLORY, SHARON A (WIG STYLIST 1/5/03)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:A
Last Name:GUILLORY
Suffix:
Gender:F
Credentials:WIG STYLIST 1/5/03
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5441 S HULEN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132
Mailing Address - Country:US
Mailing Address - Phone:817-346-4951
Mailing Address - Fax:
Practice Address - Street 1:5441 S HULEN STREET
Practice Address - Street 2:DONA'S WIGS
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132
Practice Address - Country:US
Practice Address - Phone:817-346-4951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25149512174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist