Provider Demographics
NPI:1730052119
Name:RESTORED CROWN LLC
Entity type:Organization
Organization Name:RESTORED CROWN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LONNESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON-MCDANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:COSMETOLOGIST
Authorized Official - Phone:716-703-1755
Mailing Address - Street 1:4498 MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3826
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2658 DELEWARE AVE.
Practice Address - Street 2:STE. 6
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216
Practice Address - Country:US
Practice Address - Phone:716-339-3107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty