Provider Demographics
NPI:1548933344
Name:SMITH, AKEYA EVETTE
Entity type:Individual
Prefix:
First Name:AKEYA
Middle Name:EVETTE
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 1:735 E 42ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-6502
Mailing Address - Country:US
Mailing Address - Phone:646-361-7440
Mailing Address - Fax:347-626-2250
Practice Address - Street 1:379 DEWITT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-6602
Practice Address - Country:US
Practice Address - Phone:646-361-7440
Practice Address - Fax:347-626-2250
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAEC-18-054681744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management