MEDICARE: MONIQUE 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	SP033416	PA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AC008632	MD
3	363L00000X	Nurse Practitioner	L8-0010879	DE

General Provider Information

NPI Number	:	1962385773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE SMITH

Provider Business Mailing Address
First Line	:	1510 RAINER RD
Second Line	:
City	:	BROOKHAVEN
State	:	PA
Zip	:	19015-1942
Country	:	US
Telephone Number	:	267-595-5249
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 RAINER RD
Second Line	:
City	:	BROOKHAVEN
State	:	PA
Zip	:	19015-1942
Country	:	US
Telephone Number	:	267-595-5249
Fax Number	:

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

Provider Enumeration Date	:	07/29/2025
Last Update Date	:	02/17/2026

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Directions to “ MONIQUE SMITH ” Practice Location

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