MEDICARE: SHERMAN SMOOT JR.

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	376K00000X	Nurse's Aide	401448051012	OH

General Provider Information

NPI Number	:	1578374450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERMAN SMOOT JR.

Provider Business Mailing Address
First Line	:	1300 CRESTLINE AVE APT 408
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-3064
Country	:	US
Telephone Number	:	216-250-1955
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 CRESTLINE AVE APT 408
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-3064
Country	:	US
Telephone Number	:	216-250-1955
Fax Number	:

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

Provider Enumeration Date	:	01/18/2025
Last Update Date	:	01/27/2025

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Directions to “ SHERMAN SMOOT JR. ” Practice Location

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