MEDICARE: SADE ANDREA 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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1841141231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SADE ANDREA SMITH

Provider Business Mailing Address
First Line	:	11424 ANTEBELLUM DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28273-3602
Country	:	US
Telephone Number	:	704-526-5416
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 BAXTER ST STE 450
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-3026
Country	:	US
Telephone Number	:	704-366-1075
Fax Number	:

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

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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Directions to “ SADE ANDREA SMITH ” Practice Location

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