Provider Demographics
NPI:1336970482
Name:SMITH, SHURLAND E
Entity type:Individual
Prefix:MS
First Name:SHURLAND
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHURLAND
Other - Middle Name:E
Other - Last Name:JUNIOUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:306 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-5517
Mailing Address - Country:US
Mailing Address - Phone:347-409-6642
Mailing Address - Fax:
Practice Address - Street 1:306 MILLER AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-5517
Practice Address - Country:US
Practice Address - Phone:347-409-6642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1357077252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency