MEDICARE: TARA LEA 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	374J00000X	Doula

General Provider Information

NPI Number	:	1639059074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA LEA SMITH

Provider Business Mailing Address
First Line	:	3260 CRUGER AVE APT 2E
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-6435
Country	:	US
Telephone Number	:	347-737-6397
Fax Number	:

Provider Business Practice Location Address
First Line	:	3260 CRUGER AVE APT 2E
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-6435
Country	:	US
Telephone Number	:	347-737-6397
Fax Number	:

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

Provider Enumeration Date	:	09/05/2025
Last Update Date	:	09/05/2025

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Directions to “ TARA LEA SMITH ” Practice Location

Language	Start Address	Practice Location

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