Healthcare Provider Details

I. General information

NPI: 1568714467
Provider Name (Legal Business Name): RACHEL ELIZABETH MOYAL-SMITH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL SMITH

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 NEW SCOTLAND AVE
ALBANY NY
12208
US

IV. Provider business mailing address

18 IRIS ST UNIT 2
GLENMONT NY
12077
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-3494
  • Fax:
Mailing address:
  • Phone: 518-423-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number016011
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: