Provider Demographics
NPI:1154019297
Name:SMITH, PAMELA SHANICE (MSML)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:SHANICE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSML
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 11TH ST SE
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-8211
Mailing Address - Country:US
Mailing Address - Phone:330-309-6445
Mailing Address - Fax:
Practice Address - Street 1:1290 WALNUT RD SE # B107
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-8214
Practice Address - Country:US
Practice Address - Phone:330-309-6445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant