MEDICARE: FORMEKA 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	385H00000X	Respite Care

General Provider Information

NPI Number	:	1386596682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FORMEKA SMITH

Provider Business Mailing Address
First Line	:	3640 E 105TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-2410
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3640 E 105TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-2410
Country	:	US
Telephone Number	:	216-744-5619
Fax Number	:

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

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	02/10/2026

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Directions to “ FORMEKA SMITH ” Practice Location

Language	Start Address	Practice Location

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