Provider Demographics
NPI:1114750460
Name:SMITH, SORAYA MICHELLE (MED)
Entity type:Individual
Prefix:
First Name:SORAYA
Middle Name:MICHELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23309 N 17TH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-6306
Mailing Address - Country:US
Mailing Address - Phone:602-882-4238
Mailing Address - Fax:
Practice Address - Street 1:23309 N 17TH DR STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-6306
Practice Address - Country:US
Practice Address - Phone:602-882-4238
Practice Address - Fax:480-867-0952
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst