Most Relevant Information
Provider Data
| NPI Number: | 1003653536 |
| Provider Name: | SHELLY SMITH |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/11/2024 |
| Last Updated: | 07/11/2024 |
Provider Practice Location
59 KNOB RD
PETERSBURG
WV
268478807
Practice Location Phone/Fax
| Phone: | 3044394708 |
| Fax: |
Provider Mailing Location
10 MAPLE HILL AVE STE 5
PETERSBURG
WV
268471590
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |