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NPI Code Detail

MEDICARE: MRS. CHARVETTA TERRIA SHANAE SMITH RN

MEDICARE: MRS. CHARVETTA TERRIA SHANAE SMITH RN
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
1163W00000XRegistered NurseRN.522401OH

General Provider Information

NPI Number : 1538822713
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CHARVETTA TERRIA SHANAE SMITH RN
Provider Business Mailing Address
First Line : 3471 E 145TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44120-4142
Country : US
Telephone Number : 440-656-7262
Fax Number :
Provider Business Practice Location Address
First Line : 815 SUPERIOR AVE STE 1618
Second Line :
City : CLEVELAND
State : OH
Zip : 44114-2709
Country : US
Telephone Number : 216-202-5273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2021
Last Update Date : 12/07/2025

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