MEDICARE: SHAREE LEEN SMITH PA-C

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	363A00000X	Physician Assistant	3290	TN
2	363A00000X	Physician Assistant	0010-07262	NC

General Provider Information

NPI Number	:	1235651415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAREE LEEN SMITH PA-C

Provider Business Mailing Address
First Line	:	1632 POCOSIN RD
Second Line	:
City	:	WINTERVILLE
State	:	NC
Zip	:	28590-7704
Country	:	US
Telephone Number	:	865-660-1467
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 MALLOY ST STE B
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-4477
Country	:	US
Telephone Number	:	919-751-7665
Fax Number	:

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

Provider Enumeration Date	:	07/10/2017
Last Update Date	:	11/18/2024

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