Healthcare Provider Details

I. General information

NPI: 1114418183
Provider Name (Legal Business Name): SHENIKA CHERELLE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 S 12TH ST STE 306
RICHMOND VA
23219-4282
US

IV. Provider business mailing address

440 MONTICELLO AVE STE 1848
NORFOLK VA
23510-2571
US

V. Phone/Fax

Practice location:
  • Phone: 804-396-0706
  • Fax: 757-210-3907
Mailing address:
  • Phone: 757-955-8421
  • Fax: 757-210-3907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO0002123
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number1234873
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: