MEDICARE: MAKANYA LATASHA SARVERA SMITH

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	376J00000X	Homemaker		OH
2	171M00000X	Case Manager/Care Coordinator		OH
3	175T00000X	Peer Specialist	FPS.000101	OH
4	101YA0400X	Addiction (Substance Use Disorder) Counselor	178538	OH

General Provider Information

NPI Number	:	1083475255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKANYA LATASHA SARVERA SMITH

Provider Business Mailing Address
First Line	:	3441 W 52ND ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-5817
Country	:	US
Telephone Number	:	216-799-9944
Fax Number	:

Provider Business Practice Location Address
First Line	:	3441 W 52ND ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-5817
Country	:	US
Telephone Number	:	216-799-9944
Fax Number	:

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

Provider Enumeration Date	:	01/16/2024
Last Update Date	:	01/27/2026

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Directions to “ MAKANYA LATASHA SARVERA SMITH ” Practice Location

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