Provider Demographics
NPI:1780138354
Name:SMOLIK, SHAINA KRISTIE (NP)
Entity type:Individual
Prefix:MRS
First Name:SHAINA
Middle Name:KRISTIE
Last Name:SMOLIK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHAINA
Other - Middle Name:KRISTIE
Other - Last Name:VACZY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 FIRST AVENUE
Mailing Address - Street 2:8TH FLOOR PEDIATRICS
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129
Mailing Address - Country:US
Mailing Address - Phone:617-952-5800
Mailing Address - Fax:617-952-5968
Practice Address - Street 1:300 FIRST AVENUE
Practice Address - Street 2:8TH FLOOR PEDIATRICS
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129
Practice Address - Country:US
Practice Address - Phone:617-952-5800
Practice Address - Fax:617-952-5968
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2299260208M00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics