Provider Demographics
NPI:1548730138
Name:SMITH, BRIANA SHAYRON
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:SHAYRON
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12370 MOUNT CLARE PL UNIT 12303
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-4555
Mailing Address - Country:US
Mailing Address - Phone:240-355-1343
Mailing Address - Fax:
Practice Address - Street 1:150 Q ST NE 1427
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001
Practice Address - Country:US
Practice Address - Phone:202-421-9215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
DCPRC200001715101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant