Provider Demographics
NPI:1093379273
Name:SMITH, SHANIKA CARMELLA (CNA)
Entity Type:Individual
Prefix:
First Name:SHANIKA
Middle Name:CARMELLA
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6118 MARBLE HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-5878
Mailing Address - Country:US
Mailing Address - Phone:346-285-2244
Mailing Address - Fax:832-437-0421
Practice Address - Street 1:6118 MARBLE HOLLOW LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-5878
Practice Address - Country:US
Practice Address - Phone:346-285-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXNA0060024089376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program