Provider Demographics
NPI:1205600764
Name:SMART HEALTH MEDICAL & BEAHVIORAL SERVICES LLC
Entity type:Organization
Organization Name:SMART HEALTH MEDICAL & BEAHVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP/PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:ZUWENA
Authorized Official - Middle Name:MOHAMMED
Authorized Official - Last Name:IDDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-755-7162
Mailing Address - Street 1:906 MILESTONE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10770 COLUMBIA PIKE STE 300
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4439
Practice Address - Country:US
Practice Address - Phone:443-863-9930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty