Provider Demographics
NPI:1881352417
Name:SMITH, SHAYIAH P
Entity type:Individual
Prefix:
First Name:SHAYIAH
Middle Name:P
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 1:417 S OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-5537
Mailing Address - Country:US
Mailing Address - Phone:516-382-1561
Mailing Address - Fax:877-308-8687
Practice Address - Street 1:417 S OCEAN AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-5537
Practice Address - Country:US
Practice Address - Phone:516-382-1561
Practice Address - Fax:877-308-8687
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker