Provider Demographics
NPI:1831844661
Name:AMOR WIGS AND EXTENSIONS
Entity type:Organization
Organization Name:AMOR WIGS AND EXTENSIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOHNEA
Authorized Official - Middle Name:JARESE
Authorized Official - Last Name:SHERROD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-663-9610
Mailing Address - Street 1:3419 VIRGINIA BEACH BLVD # 5462
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4419
Mailing Address - Country:US
Mailing Address - Phone:757-663-9610
Mailing Address - Fax:757-250-9720
Practice Address - Street 1:3419 VIRGINIA BEACH BLVD # 5462
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4419
Practice Address - Country:US
Practice Address - Phone:757-663-9610
Practice Address - Fax:757-250-9720
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMOR WIGS AND EXTENSIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-21
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier