Provider Demographics
NPI:1437615838
Name:SMITH, DAMONYAE M
Entity Type:Individual
Prefix:
First Name:DAMONYAE
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 GALLERY ST
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3862
Mailing Address - Country:US
Mailing Address - Phone:276-494-9575
Mailing Address - Fax:
Practice Address - Street 1:6300 GALLERY ST
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-3862
Practice Address - Country:US
Practice Address - Phone:276-494-9575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant