MEDICARE: SHENA NESMITH

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1699122457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHENA NESMITH

Provider Business Mailing Address
First Line	:	6217 W JEFFERSON ST
Second Line	:	APT A
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-4532
Country	:	US
Telephone Number	:	267-838-1145
Fax Number	:

Provider Business Practice Location Address
First Line	:	6217 W JEFFERSON ST
Second Line	:	APT A
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-4532
Country	:	US
Telephone Number	:	267-838-1145
Fax Number	:

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

Provider Enumeration Date	:	05/20/2016
Last Update Date	:	05/20/2016

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Directions to “ SHENA NESMITH ” Practice Location

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