Provider Demographics
NPI:1124169677
Name:SMITH, SHIELA V (PA)
Entity type:Individual
Prefix:MRS
First Name:SHIELA
Middle Name:V
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SHIELA
Other - Middle Name:
Other - Last Name:KO YANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:280 PROSPECT PARK W APT 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-6243
Mailing Address - Country:US
Mailing Address - Phone:347-223-4764
Mailing Address - Fax:
Practice Address - Street 1:263 7TH AVE
Practice Address - Street 2:SUITE 4B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-7247
Practice Address - Country:US
Practice Address - Phone:718-246-8610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant