Provider Demographics
NPI:1760085799
Name:SMITH, SHAQUITA LAVONNDA
Entity Type:Individual
Prefix:
First Name:SHAQUITA
Middle Name:LAVONNDA
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 1:5123 FITCH ST SE APT 204
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-5962
Mailing Address - Country:US
Mailing Address - Phone:202-660-8992
Mailing Address - Fax:
Practice Address - Street 1:3044 THAYER ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-2505
Practice Address - Country:US
Practice Address - Phone:202-529-8472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant