Provider Demographics
NPI:1861131385
Name:BLAKELY, ASHAY (HAIRLOSS PRACTITION)
Entity type:Individual
Prefix:
First Name:ASHAY
Middle Name:
Last Name:BLAKELY
Suffix:
Gender:F
Credentials:HAIRLOSS PRACTITION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SONNING RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2507
Mailing Address - Country:US
Mailing Address - Phone:803-497-4825
Mailing Address - Fax:
Practice Address - Street 1:107 N ROYAL TOWER DR STE I
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2782
Practice Address - Country:US
Practice Address - Phone:803-497-4825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other