MEDICARE: MRS. JACQUELINE MAHADY SMITH FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F333737	NY

General Provider Information

NPI Number	:	1073529590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELINE MAHADY SMITH FNP

Provider Business Mailing Address
First Line	:	3906 E GENESEE ST
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13214-1934
Country	:	US
Telephone Number	:	315-251-1093
Fax Number	:	315-251-1571

Provider Business Practice Location Address
First Line	:	3906 E GENESEE ST
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13214-1934
Country	:	US
Telephone Number	:	315-251-1093
Fax Number	:	315-251-1571

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	01/21/2021

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