Individual
SHA-SHANA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
150 N MAIN ST, MANCHESTER, CT 06042-2086
(860) 528-1359
Mailing address
150 N MAIN ST, MANCHESTER, CT 06042-2086
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
095202
CT
Other
Enumeration date
04/03/2017
Last updated
04/03/2017
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