MEDICARE: TYBEE SHANAI 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	171M00000X	Case Manager/Care Coordinator		TX

General Provider Information

NPI Number	:	1659235273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYBEE SHANAI SMITH

Provider Business Mailing Address
First Line	:	505 CYPRESS STATION DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-1634
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 CYPRESS STATION DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-1634
Country	:	US
Telephone Number	:	281-854-7199
Fax Number	:

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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