Provider Demographics
NPI:1790445856
Name:SHALONDA NICHOLE BEAUTY LLC
Entity Type:Organization
Organization Name:SHALONDA NICHOLE BEAUTY LLC
Other - Org Name:SHALUXE TRESSES
Other - Org Type:Other Name
Authorized Official - Title/Position:CRANIAL PROTHESIS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SHALONDA
Authorized Official - Middle Name:N
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-810-3593
Mailing Address - Street 1:295 WORTH AVE # 1011
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-1596
Mailing Address - Country:US
Mailing Address - Phone:202-810-3593
Mailing Address - Fax:800-914-9740
Practice Address - Street 1:17650 POSSUM POINT RD # C-6A
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-2674
Practice Address - Country:US
Practice Address - Phone:202-810-3593
Practice Address - Fax:800-914-9740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-29
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier