Healthcare Provider Details

I. General information

NPI: 1275329922
Provider Name (Legal Business Name): SAMONE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 ADAMS ST
NEW BRITAIN CT
06052-1248
US

IV. Provider business mailing address

77 ADAMS ST
NEW BRITAIN CT
06052-1248
US

V. Phone/Fax

Practice location:
  • Phone: 860-913-0428
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: