Provider Demographics
NPI:1366037459
Name:SMITH, DEBORAH SHINTA
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:SHINTA
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22851 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-1990
Mailing Address - Country:US
Mailing Address - Phone:158-594-4003
Mailing Address - Fax:586-944-0030
Practice Address - Street 1:22851 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1990
Practice Address - Country:US
Practice Address - Phone:158-594-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI230005290040600376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide