Provider Demographics
NPI:1811649965
Name:SMITH, TYRONDA DEVON (ND)
Entity type:Individual
Prefix:
First Name:TYRONDA
Middle Name:DEVON
Last Name:SMITH
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5023 N 18TH ST APT 218
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4038
Mailing Address - Country:US
Mailing Address - Phone:313-806-4686
Mailing Address - Fax:
Practice Address - Street 1:20801 N SCOTTSDALE RD STE 205
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7411
Practice Address - Country:US
Practice Address - Phone:480-388-3265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21-1665175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ21-1665OtherAZND BOARD