Provider Demographics
NPI:1952002727
Name:SMAJDA, SHANNON RACHELLE (CPM)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:RACHELLE
Last Name:SMAJDA
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 HIGHWAY 76
Mailing Address - Street 2:
Mailing Address - City:COTTONTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37048-4909
Mailing Address - Country:US
Mailing Address - Phone:303-260-8616
Mailing Address - Fax:
Practice Address - Street 1:3232 HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:COTTONTOWN
Practice Address - State:TN
Practice Address - Zip Code:37048-4909
Practice Address - Country:US
Practice Address - Phone:303-260-8616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN126176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife