Provider Demographics
NPI:1346072857
Name:SMITH, SHAYDEN SOPHIA
Entity type:Individual
Prefix:
First Name:SHAYDEN
Middle Name:SOPHIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N HANCHETT ST APT 211
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-1696
Mailing Address - Country:US
Mailing Address - Phone:517-617-2516
Mailing Address - Fax:
Practice Address - Street 1:20 N HANCHETT ST APT 211
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-1696
Practice Address - Country:US
Practice Address - Phone:517-617-2516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula