Provider Demographics
NPI:1578374450
Name:SMOOT, SHERMAN JR
Entity type:Individual
Prefix:
First Name:SHERMAN
Middle Name:
Last Name:SMOOT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 CRESTLINE AVE APT 408
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-3064
Mailing Address - Country:US
Mailing Address - Phone:216-250-1955
Mailing Address - Fax:
Practice Address - Street 1:1300 CRESTLINE AVE APT 408
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-3064
Practice Address - Country:US
Practice Address - Phone:216-250-1955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-18
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401448051012376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty