Provider Demographics
NPI:1700246352
Name:BAIN, SHARISSA (HAIRLOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:SHARISSA
Middle Name:
Last Name:BAIN
Suffix:
Gender:F
Credentials:HAIRLOSS SPECIALIST
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Other - Credentials:
Mailing Address - Street 1:160 EMBASSY DR APT 105
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-7336
Mailing Address - Country:US
Mailing Address - Phone:910-729-2578
Mailing Address - Fax:
Practice Address - Street 1:12740 S TRYON ST STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-7276
Practice Address - Country:US
Practice Address - Phone:910-729-2578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management