Provider Demographics
NPI:1063106813
Name:EPIC LOOKS HAIR AND WIGS COLLECTION LC
Entity type:Organization
Organization Name:EPIC LOOKS HAIR AND WIGS COLLECTION LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRANIAL PROTHESIS
Authorized Official - Prefix:
Authorized Official - First Name:KAYON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-618-8402
Mailing Address - Street 1:1213 CODA CT # 31
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:FL
Mailing Address - Zip Code:33838-4038
Mailing Address - Country:US
Mailing Address - Phone:863-618-8402
Mailing Address - Fax:
Practice Address - Street 1:6250 CYPRESS GARDENS BLVD STE 27
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-3158
Practice Address - Country:US
Practice Address - Phone:954-951-4310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty