Provider Demographics
NPI:1790105682
Name:SMITH, SHEREA MONICA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEREA
Middle Name:MONICA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-454-6300
Mailing Address - Fax:833-969-0131
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV PED ACADEMICS, STE 2D
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6300
Practice Address - Fax:833-969-0131
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2024-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2017010075208000000X, 2081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200029268Medicaid