Provider Demographics
NPI:1356940217
Name:AJESH, SMITHA (APRN)
Entity type:Individual
Prefix:
First Name:SMITHA
Middle Name:
Last Name:AJESH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1790 E VENICE AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-3191
Mailing Address - Country:US
Mailing Address - Phone:941-488-8884
Mailing Address - Fax:941-488-5554
Practice Address - Street 1:1790 E VENICE AVE STE 204
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-3191
Practice Address - Country:US
Practice Address - Phone:941-488-8884
Practice Address - Fax:941-488-5554
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11009329363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health