1699667618 NPI number — REMEDY SKIN, HAIR AND WELLNESS PLLC

Table of content: (NPI 1699667618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699667618 NPI number — REMEDY SKIN, HAIR AND WELLNESS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REMEDY SKIN, HAIR AND WELLNESS PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699667618
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1235 EAST BLVD
Provider Second Line Business Mailing Address:
SUITE E #436
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
980-983-3989
Provider Business Mailing Address Fax Number:
980-966-5737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4417 OGLUKIAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28226-5119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-983-3989
Provider Business Practice Location Address Fax Number:
980-966-5737
Provider Enumeration Date:
07/15/2025

Additional Information

Authorized Official

Authorized Official Last Name:
DANIEL
Authorized Official First Name:
ALYSSA
Authorized Official Middle Name:
SEARLES
Authorized Official Title or Position:
OWNER/ PHYSICIAN
Authorized Official Telephone Number:
980-983-3989

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1013233352 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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