Provider Demographics
NPI:1497252076
Name:SMITH, SHONTE' (IBCLC)
Entity Type:Individual
Prefix:
First Name:SHONTE'
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:SHONTE
Other - Middle Name:
Other - Last Name:TERHUNE-SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IBCLC
Mailing Address - Street 1:4207 WHISPERING OAK DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-5541
Mailing Address - Country:US
Mailing Address - Phone:810-308-8787
Mailing Address - Fax:
Practice Address - Street 1:436 S SAGINAW ST STE 300
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502-1830
Practice Address - Country:US
Practice Address - Phone:810-213-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-136432174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN