Organization
MELANIN RAE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAYLA RANDALL (CRANIAL PROSTHESIS SPECIALIST)
(602) 579-1634
Entity
Organization
Contact information
Practice address
202 APPLETON DR, GOOSE CREEK, SC 29445-7713
(602) 579-1634
Mailing address
202 APPLETON DR, GOOSE CREEK, SC 29445-7713
(602) 579-1634
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
—
Other
Enumeration date
06/22/2024
Last updated
06/22/2024
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