Healthcare Provider Details

I. General information

NPI: 1467392464
Provider Name (Legal Business Name): RYAN ELIZABETH SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 EDEN WAY N STE 110
CHESAPEAKE VA
23320-2776
US

IV. Provider business mailing address

149 PLANTATION RIDGE DR STE 140
MOORESVILLE NC
28117-9175
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-3560
  • Fax: 704-251-6746
Mailing address:
  • Phone: 757-547-3560
  • Fax: 704-251-6746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2101003000
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: