Provider Demographics
NPI:1457933319
Name:PECULIAR BEAUTY LLC
Entity type:Organization
Organization Name:PECULIAR BEAUTY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELIA
Authorized Official - Middle Name:RAMONA
Authorized Official - Last Name:BURDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DME & SUPPLIES
Authorized Official - Phone:757-582-3266
Mailing Address - Street 1:201 STANDARD LN APT 107
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3765
Mailing Address - Country:US
Mailing Address - Phone:757-582-3266
Mailing Address - Fax:
Practice Address - Street 1:328 LYNN SHORES DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-2416
Practice Address - Country:US
Practice Address - Phone:757-917-5642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies