MEDICARE: SHERYL SUGRUE 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	:	1679896096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERYL SUGRUE SMITH

Provider Business Mailing Address
First Line	:	344 DAVIES AVE
Second Line	:
City	:	WEST HENRIETTA
State	:	NY
Zip	:	14586-8807
Country	:	US
Telephone Number	:	585-444-0195
Fax Number	:	585-368-4815

Provider Business Practice Location Address
First Line	:	344 DAVIES AVE
Second Line	:
City	:	WEST HENRIETTA
State	:	NY
Zip	:	14586-8807
Country	:	US
Telephone Number	:	585-444-0195
Fax Number	:	585-368-4815

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

Provider Enumeration Date	:	03/12/2010
Last Update Date	:	03/12/2010

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