Healthcare Provider Details

I. General information

NPI: 1871053439
Provider Name (Legal Business Name): SHEMELE BRELAUN SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 09/05/2022
Certification Date: 09/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 W ASHLAN AVE
FRESNO CA
93722-4307
US

IV. Provider business mailing address

4711 W ASHLAN AVE
FRESNO CA
93722-4307
US

V. Phone/Fax

Practice location:
  • Phone: 559-203-6660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA181293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: