Provider Demographics
NPI:1467645341
Name:SMITH, SHERI MICHELE
Entity type:Individual
Prefix:MISS
First Name:SHERI
Middle Name:MICHELE
Last Name: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 1:5205 N 24TH ST
Mailing Address - Street 2:#105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3581
Mailing Address - Country:US
Mailing Address - Phone:480-747-2660
Mailing Address - Fax:
Practice Address - Street 1:4650 WEST SWEETWATER
Practice Address - Street 2:WASHINGTON ELEMENTARY SCHOOL DISTRICT
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304
Practice Address - Country:US
Practice Address - Phone:602-347-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP5572251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)