Individual
SHANNON SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1810 W ROCKLAND ST, PHILADELPHIA, PA 19141-1017
(267) 709-3079
Mailing address
1810 W ROCKLAND ST, PHILADELPHIA, PA 19141-1017
(267) 709-3079
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
69043601
PA
Other
Enumeration date
12/05/2022
Last updated
09/11/2025
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