Provider Demographics
NPI:1770154338
Name:SMITH, DEEDRA (HAIRLOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:DEEDRA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:HAIRLOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 EDWARD DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823-1664
Mailing Address - Country:US
Mailing Address - Phone:201-275-8540
Mailing Address - Fax:
Practice Address - Street 1:24 EDWARD DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:NJ
Practice Address - Zip Code:08823-1664
Practice Address - Country:US
Practice Address - Phone:201-275-8540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist