Individual
MIESHA MCCORMICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
HAIR LOSS SPECIALIST
Contact information
Practice address
876 SUNRISE HWY STE 16, BAY SHORE, NY 11706-5908
(631) 522-0548
Mailing address
138 W 16TH ST, DEER PARK, NY 11729-4907
(631) 522-0548
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
—
Other
Enumeration date
12/15/2017
Last updated
12/15/2017
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