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General NPI Number Information
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NPI Number | 1164398996
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Entity Type | Individual
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Provider Name | ROSHODA TAKEEMA TASHIANA SMITH
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Gender | Female
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Dates
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Enumeration Date | 10/17/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 620 MADISON ST
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City | SYRACUSE
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State | NY
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Zip | 13210-2319
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Country | US
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Telephone | 315-426-3600
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Fax | 315-426-3605
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Provider Business Mailing Address
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Address Line | 182 AVENUE D APT 203
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City | ROCHESTER
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State | NY
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Zip | 14621-4461
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Country | US
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Telephone | 585-524-9919
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 99257601
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License Number State | NY
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