Provider Demographics
NPI:1588128284
Name:SMITH, SHARISSE NAPUALANI
Entity type:Individual
Prefix:
First Name:SHARISSE
Middle Name:NAPUALANI
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARISSE
Other - Middle Name:NAPUALANI COLOMA
Other - Last Name:NAGATORI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:132 LENNY RD
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:NY
Mailing Address - Zip Code:13625
Mailing Address - Country:US
Mailing Address - Phone:315-244-7903
Mailing Address - Fax:
Practice Address - Street 1:50 LEROY ST
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676
Practice Address - Country:US
Practice Address - Phone:315-274-9102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-27
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028188363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant