MEDICARE: MS. NEVAEH SMITH RBT

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	106S00000X	Behavior Technician		NC

General Provider Information

NPI Number	:	1700742434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NEVAEH SMITH RBT

Provider Business Mailing Address
First Line	:	10220 PROSPERITY PARK DR STE 300
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-1106
Country	:	US
Telephone Number	:	800-701-0498
Fax Number	:

Provider Business Practice Location Address
First Line	:	10220 PROSPERITY PARK DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-1105
Country	:	US
Telephone Number	:	800-701-0498
Fax Number	:

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

Provider Enumeration Date	:	12/26/2025
Last Update Date	:	12/26/2025

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