Provider Demographics
NPI:1669141602
Name:SMITH, JAMIYA SHAUDE
Entity type:Individual
Prefix:
First Name:JAMIYA
Middle Name:SHAUDE
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:PO BOX 77
Mailing Address - Street 2:
Mailing Address - City:HUTTIG
Mailing Address - State:AR
Mailing Address - Zip Code:71747-0077
Mailing Address - Country:US
Mailing Address - Phone:832-943-9087
Mailing Address - Fax:
Practice Address - Street 1:880 HIGHWAY 6 S
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1034
Practice Address - Country:US
Practice Address - Phone:832-943-9087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
15398162OtherCAPQ