Individual
SHALITA SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
100 S TAYLOR AVE., ESSEX, MD 21221
(443) 739-2084
Mailing address
4806 MANTLEWOOD WAY APT 102, ABERDEEN, MD 21001-3646
(443) 739-2084
(410) 238-7463
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
03-050
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2188G72M
MEDICAL ASSISTANCE/MEDICARE/MEDICAID/PRIVATE
MD
Enumeration date
10/06/2021
Last updated
10/06/2021
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