Provider Demographics
NPI:1104423714
Name:SHANNON NICOLE BEAUTY
Entity type:Organization
Organization Name:SHANNON NICOLE BEAUTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-418-4201
Mailing Address - Street 1:2147 S LAMBERT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-3503
Mailing Address - Country:US
Mailing Address - Phone:516-418-4201
Mailing Address - Fax:
Practice Address - Street 1:239 FOURTH AVENUE STE 1401 #1462
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:PA
Practice Address - Zip Code:15222
Practice Address - Country:US
Practice Address - Phone:516-418-4201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment