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NPI Code Detail

MEDICARE: SHA VONN SMITH

MEDICARE: SHA VONN 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
1106S00000XBehavior TechnicianCA

General Provider Information

NPI Number : 1629936596
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHA VONN SMITH
Provider Business Mailing Address
First Line : 150 GLEN COVE MARINA RD E STE 102
Second Line :
City : VALLEJO
State : CA
Zip : 94591-7237
Country : US
Telephone Number : 877-910-6538
Fax Number :
Provider Business Practice Location Address
First Line : 150 GLEN COVE MARINA RD E STE 102
Second Line :
City : VALLEJO
State : CA
Zip : 94591-7237
Country : US
Telephone Number : 877-910-6538
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2026
Last Update Date : 01/12/2026

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Directions to “ SHA VONN SMITH ” Practice Location

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