Provider Demographics
NPI:1548753742
Name:SMITH, SHALANDREA
Entity Type:Individual
Prefix:
First Name:SHALANDREA
Middle Name:
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 1:1551 ANACOSTIA AVE NE APT 34
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-2030
Mailing Address - Country:US
Mailing Address - Phone:202-749-6107
Mailing Address - Fax:
Practice Address - Street 1:1551 ANACOSTIA AVE NE APT 34
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-2030
Practice Address - Country:US
Practice Address - Phone:202-749-6107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant