Provider Demographics
NPI:1750962742
Name:GRANT, ERIKA MONSHELLE (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:MONSHELLE
Last Name:GRANT
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E 59TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-4810
Mailing Address - Country:US
Mailing Address - Phone:917-604-5044
Mailing Address - Fax:
Practice Address - Street 1:100 E 59TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-4810
Practice Address - Country:US
Practice Address - Phone:917-604-5044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No174400000XOther Service ProvidersSpecialist
No335E00000XSuppliersProsthetic/Orthotic Supplier