Provider Demographics
NPI:1912496746
Name:SMITH, KERRY-ANN KEISHA (RDMS)
Entity Type:Individual
Prefix:
First Name:KERRY-ANN
Middle Name:KEISHA
Last Name:SMITH
Suffix:
Gender:F
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 BEACH 102ND ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2871
Mailing Address - Country:US
Mailing Address - Phone:347-497-6200
Mailing Address - Fax:
Practice Address - Street 1:230 BEACH 102ND ST STE 2B
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2871
Practice Address - Country:US
Practice Address - Phone:347-497-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133816156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist