Provider Demographics
NPI:1093408825
Name:SMITH, MONIQUE (DCN)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:DCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3106 RAMSGATE PL
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-2157
Mailing Address - Country:US
Mailing Address - Phone:240-506-2086
Mailing Address - Fax:
Practice Address - Street 1:3106 RAMSGATE PL
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-2157
Practice Address - Country:US
Practice Address - Phone:240-506-2086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5582133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist