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General NPI Number Information
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NPI Number | 1831700715
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Entity Type | Organization
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Legal Business Name | TREE OF LIFE INTEGRATIVE FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 08/13/2020
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Last Update Date | 08/11/2023
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Provider Practice Location Address
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Address Line | 200 NEW RD
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City | LINWOOD
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State | NJ
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Zip | 08221-1306
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Country | US
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Telephone | 609-354-5553
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Fax | 609-438-7216
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Provider Business Mailing Address
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Address Line | 532 OLD MARLTON PIKE W PMB 752
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City | MARLTON
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State | NJ
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Zip | 08053
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHAKEILLA LAVERN SMITHBEY
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Credential | MD
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Telephone | 609-354-5553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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