Provider Demographics
NPI:1285363226
Name:SMART, SAMUEL JOHN (MS, CF-SLP)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:JOHN
Last Name:SMART
Suffix:
Gender:M
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 ARAGONA BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5336
Mailing Address - Country:US
Mailing Address - Phone:757-705-8310
Mailing Address - Fax:
Practice Address - Street 1:301 CLEARFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4017
Practice Address - Country:US
Practice Address - Phone:757-315-8746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000957235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist