Provider Demographics
NPI:1609400027
Name:SMITH, SHEREE TYWANN
Entity Type:Individual
Prefix:
First Name:SHEREE
Middle Name:TYWANN
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 1:5344 E 131ST ST
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-3245
Mailing Address - Country:US
Mailing Address - Phone:216-640-6657
Mailing Address - Fax:
Practice Address - Street 1:5344 E 131ST ST
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-3245
Practice Address - Country:US
Practice Address - Phone:216-640-6657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide