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General NPI Number Information
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NPI Number | 1154460632
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Entity Type | Individual
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Provider Name | SHARON LYNN SMITH PA
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Gender | Female
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1250 FOREST AVE
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City | PORTLAND
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State | ME
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Zip | 04103-1884
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Country | US
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Telephone | 207-878-3177
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Fax |
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Provider Business Mailing Address
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Address Line | 111 LONGVIEW DR
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City | PORTLAND
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State | ME
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Zip | 04103-2282
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Country | US
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Telephone | 207-232-6046
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA860
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License Number State | ME
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