Provider Demographics
NPI:1629742333
Name:SMALL, MASHAI LANYCE (CD)
Entity Type:Individual
Prefix:
First Name:MASHAI
Middle Name:LANYCE
Last Name:SMALL
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7080 DUCKETTS LN APT 303
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-7014
Mailing Address - Country:US
Mailing Address - Phone:912-503-0663
Mailing Address - Fax:
Practice Address - Street 1:7080 DUCKETTS LN APT 303
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-7014
Practice Address - Country:US
Practice Address - Phone:912-503-0663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty