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General NPI Number Information
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NPI Number | 1194511352
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Entity Type | Individual
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Provider Name | SHANELL BRIANA SMITH
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Gender | Female
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 110 CHURCH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19106-2201
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Country | US
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Telephone | 267-807-0550
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Fax |
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Provider Business Mailing Address
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Address Line | 336 SASSAFRAS ST
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City | BROWNS MILLS
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State | NJ
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Zip | 08015-1319
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Country | US
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Telephone | 609-332-1896
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-23-297207
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License Number State | NJ
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