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General NPI Number Information
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NPI Number | 1851020267
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Entity Type | Individual
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Provider Name | SHAQUILA SMITH
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Gender | Female
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 1804 E 55TH ST
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City | CLEVELAND
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State | OH
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Zip | 44103-3602
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Country | US
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Telephone | 216-762-1237
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Fax |
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Provider Business Mailing Address
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Address Line | 2165 W 89TH ST UNIT 8
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City | CLEVELAND
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State | OH
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Zip | 44102-3856
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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 |
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN5249104
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 162405
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License Number State | OH
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