Provider Demographics
NPI:1396994968
Name:SMITH, SHAKARA S (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SHAKARA
Middle Name:S
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 CREEKSIDE CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3741
Mailing Address - Country:US
Mailing Address - Phone:302-463-6723
Mailing Address - Fax:
Practice Address - Street 1:774 CHRISTIANA RD STE 202
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4221
Practice Address - Country:US
Practice Address - Phone:302-366-7671
Practice Address - Fax:302-366-7549
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0000633363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant