MEDICARE: SMITH MAXUME PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	F406366	NY

General Provider Information

NPI Number	:	1134940273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SMITH MAXUME PMHNP

Provider Business Mailing Address
First Line	:	28 LIBERTY BLVD
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-4834
Country	:	US
Telephone Number	:	347-737-3009
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 LIBERTY BLVD
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-4834
Country	:	US
Telephone Number	:	347-737-3009
Fax Number	:

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

Provider Enumeration Date	:	10/22/2024
Last Update Date	:	10/22/2024

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