1083133060 NPI number — MRS. DEAUDRA SHANIQUA REED-SMITH M.ED., NCC

Table of content: MRS. DEAUDRA SHANIQUA REED-SMITH M.ED., NCC (NPI 1083133060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083133060 NPI number — MRS. DEAUDRA SHANIQUA REED-SMITH M.ED., NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REED-SMITH
Provider First Name:
DEAUDRA
Provider Middle Name:
SHANIQUA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED., NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REED
Provider Other First Name:
DEAUDRA
Provider Other Middle Name:
SHANIQUA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED., NCC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083133060
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6625 TRUNK WAY UNIT I
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46221-1591
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-506-2542
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5638 PROFESSIONAL CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46241-5042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-714-1927
Provider Business Practice Location Address Fax Number:
317-745-9565
Provider Enumeration Date:
09/11/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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