Provider Demographics
NPI:1578926408
Name:SMITH, SHAYLA NICOLE
Entity Type:Individual
Prefix:MS
First Name:SHAYLA
Middle Name:NICOLE
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 1:2035 SECRET GARDEN LN UNIT 505
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4036
Mailing Address - Country:US
Mailing Address - Phone:904-505-7206
Mailing Address - Fax:
Practice Address - Street 1:2035 SECRET GARDEN LN UNIT 505
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4036
Practice Address - Country:US
Practice Address - Phone:904-505-7206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program