Provider Demographics
NPI:1477902591
Name:SMITH, SHARLENE T (PHD, MBA, MSIT)
Entity Type:Individual
Prefix:DR
First Name:SHARLENE
Middle Name:T
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD, MBA, MSIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S DALTON ST
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-3757
Mailing Address - Country:US
Mailing Address - Phone:704-524-7299
Mailing Address - Fax:
Practice Address - Street 1:102 S DALTON ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-3757
Practice Address - Country:US
Practice Address - Phone:704-524-7299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No172V00000XOther Service ProvidersCommunity Health Worker
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education