MEDICARE: SHYKELA RENEE SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MSG011924	PA

General Provider Information

NPI Number	:	1184288409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHYKELA RENEE SMITH

Provider Business Mailing Address
First Line	:	7210 OXFORD AVE APT 2M
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-4058
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7210 OXFORD AVE APT 2M
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-4058
Country	:	US
Telephone Number	:	267-258-7951
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2019
Last Update Date	:	04/23/2019

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