Provider Demographics
NPI:1417604307
Name:SMITH, SHIEKQULIA MONIQUE
Entity type:Individual
Prefix:
First Name:SHIEKQULIA
Middle Name:MONIQUE
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 1:8991 ZODIAC DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-4168
Mailing Address - Country:US
Mailing Address - Phone:513-973-8705
Mailing Address - Fax:
Practice Address - Street 1:8991 ZODIAC DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-4168
Practice Address - Country:US
Practice Address - Phone:513-973-8705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRK491507376J00000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No376J00000XNursing Service Related ProvidersHomemaker