MEDICARE: MRS. YOLONDA YVETTE SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	3747P1801X	Personal Care Attendant
2	172A00000X	Driver
3	106S00000X	Behavior Technician
4	253Z00000X	In Home Supportive Care Agency
5	3747A0650X	Attendant Care Provider

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1326012360	OTHER	OH	AGENCY NPI

General Provider Information

NPI Number	:	1881180099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YOLONDA YVETTE SMITH

Provider Business Mailing Address
First Line	:	7749 SHADY WATER LN
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45459-3688
Country	:	US
Telephone Number	:	937-329-1642
Fax Number	:

Provider Business Practice Location Address
First Line	:	7749 SHADY WATER LN
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45459-3688
Country	:	US
Telephone Number	:	937-329-1642
Fax Number	:

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

Provider Enumeration Date	:	07/11/2018
Last Update Date	:	01/15/2025

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