MEDICARE: SHIONA MARIE 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	363AS0400X	Surgical Physician Assistant	8764	AZ
2	363AM0700X	Medical Physician Assistant	8764	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PEND	OTHER	AZ	PEND

General Provider Information

NPI Number	:	1841957412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIONA MARIE SMITH PA-C

Provider Business Mailing Address
First Line	:	15000 N 83RD AVE UNIT 200
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85381-2002
Country	:	US
Telephone Number	:	623-887-2912
Fax Number	:	602-935-3200

Provider Business Practice Location Address
First Line	:	15000 N 83RD AVE UNIT 200
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85381-2002
Country	:	US
Telephone Number	:	623-887-2912
Fax Number	:

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

Provider Enumeration Date	:	11/18/2021
Last Update Date	:	01/08/2026

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Directions to “ SHIONA MARIE SMITH PA-C” Practice Location

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