Organization
SASSY SISTAS BOUTIQUE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EBONI RAINEY-HAYNES (CO-OWNER)
(407) 383-0643
Entity
Organization
Contact information
Practice address
851 W STATE ROAD 436 STE 1005, ALTAMONTE SPRINGS, FL 32714-3055
(407) 383-0643
Mailing address
851 W STATE ROAD 436 STE 1005, ALTAMONTE SPRINGS, FL 32714-3055
(407) 383-0643
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
02/17/2022
Last updated
03/04/2024
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