Provider Demographics
NPI:1205118361
Name:SMITHBEY, SHAKEILLA LAVERN (MD)
Entity type:Individual
Prefix:
First Name:SHAKEILLA
Middle Name:LAVERN
Last Name:SMITHBEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:54 E 5TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-4219
Mailing Address - Country:US
Mailing Address - Phone:856-562-0195
Mailing Address - Fax:
Practice Address - Street 1:6912 FM 1488 RD STE A
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-1527
Practice Address - Country:US
Practice Address - Phone:832-766-0631
Practice Address - Fax:281-419-6599
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10007400207Q00000X
PA457896207Q00000X
CT53081207Q00000X
TXU5612207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine