Provider Demographics
NPI:1376433276
Name:SMITH, PHYLLIS
Entity type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3849 SAINT BARNABAS RD APT T2
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-3238
Mailing Address - Country:US
Mailing Address - Phone:240-350-2943
Mailing Address - Fax:866-528-1035
Practice Address - Street 1:3849 SAINT BARNABAS RD APT T2
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-3238
Practice Address - Country:US
Practice Address - Phone:240-350-2943
Practice Address - Fax:866-528-1035
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty