Healthcare Provider Details

I. General information

NPI: 1881112324
Provider Name (Legal Business Name): STEPHANIE DEMETRIUS SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 PILLOW LN
BURLINGTON NC
27217-9466
US

IV. Provider business mailing address

183 PILLOW LN
BURLINGTON NC
27217-9466
US

V. Phone/Fax

Practice location:
  • Phone: 919-638-4201
  • Fax:
Mailing address:
  • Phone: 919-638-4201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: