Provider Demographics
NPI:1043003858
Name:SMITH, FELICIA SHAVETTA
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:SHAVETTA
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 1:208 COTTON ST
Mailing Address - Street 2:
Mailing Address - City:NORTH
Mailing Address - State:SC
Mailing Address - Zip Code:29112-8281
Mailing Address - Country:US
Mailing Address - Phone:803-308-3937
Mailing Address - Fax:803-308-3937
Practice Address - Street 1:153 FOUNDERS CT
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2087
Practice Address - Country:US
Practice Address - Phone:803-268-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-24
Last Update Date:2025-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30027363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily