Provider Demographics
NPI:1740870708
Name:SMITH, SHAQUITA LASHAY
Entity type:Individual
Prefix:
First Name:SHAQUITA
Middle Name:LASHAY
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 1:6621 MEADOWLARK LN APT B
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-2767
Mailing Address - Country:US
Mailing Address - Phone:501-786-6765
Mailing Address - Fax:
Practice Address - Street 1:6621 MEADOWLARK LN APT B
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-2767
Practice Address - Country:US
Practice Address - Phone:501-786-6765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1514141744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty