Healthcare Provider Details

I. General information

NPI: 1053240671
Provider Name (Legal Business Name): CHIARA SKY SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 W 108TH ST
NEW YORK NY
10025-2956
US

IV. Provider business mailing address

215 W 90TH ST APT 2A
NEW YORK NY
10024-1223
US

V. Phone/Fax

Practice location:
  • Phone: 212-663-3000
  • Fax:
Mailing address:
  • Phone: 212-864-4832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: