1871147504 NPI number — AKYRA ROANE HAIR LOSS SPECIALIST

Table of content: AKYRA ROANE HAIR LOSS SPECIALIST (NPI 1871147504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871147504 NPI number — AKYRA ROANE HAIR LOSS SPECIALIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROANE
Provider First Name:
AKYRA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
HAIR LOSS SPECIALIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERRY
Provider Other First Name:
AKYRA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
HAIR LOSS SPECIALIST
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871147504
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4391 IRONBOUND RD STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23188-2659
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-880-1832
Provider Business Mailing Address Fax Number:
757-260-5017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4391 IRONBOUND RD STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23188-2659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-880-1832
Provider Business Practice Location Address Fax Number:
757-260-5017
Provider Enumeration Date:
07/31/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 224P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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