MEDICARE: TESHEMA SHYDALE 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	251E00000X	Home Health Agency		OH

General Provider Information

NPI Number	:	1487407326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TESHEMA SHYDALE SMITH

Provider Business Mailing Address
First Line	:	18014 MAPLE HEIGHTS BLVD
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-2711
Country	:	US
Telephone Number	:	216-673-2014
Fax Number	:

Provider Business Practice Location Address
First Line	:	18014 MAPLE HEIGHTS BLVD
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-2711
Country	:	US
Telephone Number	:	216-673-2014
Fax Number	:

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

Provider Enumeration Date	:	04/10/2024
Last Update Date	:	04/10/2024

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