MEDICARE: SEAN MICHAEL 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	50.006217RX	OH

General Provider Information

NPI Number	:	1245879295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN MICHAEL SMITH PA-C

Provider Business Mailing Address
First Line	:	4068 SARA DR APT 204
Second Line	:
City	:	UNIONTOWN
State	:	OH
Zip	:	44685-8168
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2716 CLEVELAND AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44709-3310
Country	:	US
Telephone Number	:	330-453-7800
Fax Number	:

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

Provider Enumeration Date	:	12/22/2019
Last Update Date	:	03/04/2022

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Directions to “ SEAN MICHAEL SMITH PA-C” Practice Location

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