Healthcare Provider Details

I. General information

NPI: 1033035894
Provider Name (Legal Business Name): SMERLINE GLORIA THEODATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 DARBY TER
DARBY PA
19023-2207
US

IV. Provider business mailing address

619 DARBY TER
DARBY PA
19023-2207
US

V. Phone/Fax

Practice location:
  • Phone: 610-679-1987
  • Fax:
Mailing address:
  • Phone: 610-679-1987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: