Provider Demographics
NPI:1568726719
Name:SMITH, MECHELLE KIMBERLY
Entity Type:Individual
Prefix:MS
First Name:MECHELLE
Middle Name:KIMBERLY
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 1:641 E 96TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-1301
Mailing Address - Country:US
Mailing Address - Phone:718-485-5713
Mailing Address - Fax:
Practice Address - Street 1:641 E 96TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-1301
Practice Address - Country:US
Practice Address - Phone:718-485-5713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist