Basic Information
| Provider Information | |||||||||
| NPI: | 1285918458 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SZADA SMITH | ||||||||
| FirstName: | SHELLY | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4960 SW 72ND AVE | ||||||||
| Address2: | SUITE 406 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331555544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056625200 | ||||||||
| FaxNumber: | 3052847948 | ||||||||
| Practice Location | |||||||||
| Address1: | 11744 BEACH BLVD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322468475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042652050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2011 | ||||||||
| LastUpdateDate: | 10/05/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN9304187 | FL | Y | Nursing Service Providers | Registered Nurse |
No ID Information.