Provider Demographics
NPI:1134380504
Name:NEWHOUSE-SMITH, TIFFANY SHUNNTA
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:SHUNNTA
Last Name:NEWHOUSE-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 1:3815 LOVINGOOD DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241-4307
Mailing Address - Country:US
Mailing Address - Phone:214-680-2305
Mailing Address - Fax:214-372-1903
Practice Address - Street 1:3815 LOVINGOOD DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-4307
Practice Address - Country:US
Practice Address - Phone:214-680-2305
Practice Address - Fax:214-372-1903
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator