Provider Demographics
NPI:1487425880
Name:NEW YORK FASHION BEAUTY SUPPLY LLC
Entity type:Organization
Organization Name:NEW YORK FASHION BEAUTY SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARDAE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANHOOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-335-7702
Mailing Address - Street 1:5309 E INDEPENDENCE BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-0542
Mailing Address - Country:US
Mailing Address - Phone:980-335-7702
Mailing Address - Fax:
Practice Address - Street 1:5309 E INDEPENDENCE BLVD STE E
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-0542
Practice Address - Country:US
Practice Address - Phone:980-335-7702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty