Provider Demographics
NPI:1053064279
Name:SMITH, TASTEE F
Entity Type:Individual
Prefix:MRS
First Name:TASTEE
Middle Name:F
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TASTEE
Other - Middle Name:F
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4025 GOLDENROD CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45416-2211
Mailing Address - Country:US
Mailing Address - Phone:937-321-1286
Mailing Address - Fax:
Practice Address - Street 1:4025 GOLDENROD CT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45416-2211
Practice Address - Country:US
Practice Address - Phone:937-321-1286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
OH343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)