Provider Demographics
NPI:1750815338
Name:SMITH, SHASHONDIANDRINA JANISHA
Entity Type:Individual
Prefix:MRS
First Name:SHASHONDIANDRINA
Middle Name:JANISHA
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 1:108 CEMETARY ST APT 13
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38663-1453
Mailing Address - Country:US
Mailing Address - Phone:662-882-2422
Mailing Address - Fax:
Practice Address - Street 1:108 CEMETARY ST APT 13
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:MS
Practice Address - Zip Code:38663-1453
Practice Address - Country:US
Practice Address - Phone:662-882-2422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health