Provider Demographics
NPI:1215312541
Name:HUNT, KADIJAH CHONTAE (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:KADIJAH
Middle Name:CHONTAE
Last Name:HUNT
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 1:347 5TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-2957
Mailing Address - Country:US
Mailing Address - Phone:407-318-4086
Mailing Address - Fax:
Practice Address - Street 1:347 5TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-2957
Practice Address - Country:US
Practice Address - Phone:407-318-4086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management