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NPI Code Detail

MEDICARE: SHANNAH SMITH

MEDICARE: SHANNAH 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
1246ZC0007XSurgical Assistant

General Provider Information

NPI Number : 1700674553
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNAH SMITH
Provider Business Mailing Address
First Line : 39628 RIVER OAKS DR
Second Line :
City : PONCHATOULA
State : LA
Zip : 70454-6900
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 39628 RIVER OAKS DR
Second Line :
City : PONCHATOULA
State : LA
Zip : 70454-6900
Country : US
Telephone Number : 985-860-7806
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/30/2025
Last Update Date : 04/30/2025

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Directions to “ SHANNAH SMITH ” Practice Location

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