Provider Demographics
NPI:1003613811
Name:SMITH, SARANDA DOROTHEA
Entity type:Individual
Prefix:
First Name:SARANDA
Middle Name:DOROTHEA
Last Name:SMITH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 VALLEY GREEN DR
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-2922
Mailing Address - Country:US
Mailing Address - Phone:267-474-3313
Mailing Address - Fax:
Practice Address - Street 1:3450 VALLEY GREEN DR
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-2922
Practice Address - Country:US
Practice Address - Phone:267-474-3313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP032322363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health