Provider Demographics
NPI:1235651415
Name:SMITH, SHAREE (PA-C)
Entity Type:Individual
Prefix:
First Name:SHAREE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHAREE
Other - Middle Name:
Other - Last Name:DILDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1632 POCOSIN RD
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-7704
Mailing Address - Country:US
Mailing Address - Phone:865-660-1467
Mailing Address - Fax:
Practice Address - Street 1:204 MALLOY ST STE A
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4477
Practice Address - Country:US
Practice Address - Phone:919-751-7665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3290363A00000X
NC0010-07262363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant