Provider Demographics
NPI:1730718321
Name:SMITH, CAMERON TAYLOR (MPAS, PA-C)
Entity type:Individual
Prefix:MISS
First Name:CAMERON
Middle Name:TAYLOR
Last Name:SMITH
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 RIVERSIDE BLVD APT 705
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10069-0209
Mailing Address - Country:US
Mailing Address - Phone:972-302-7061
Mailing Address - Fax:
Practice Address - Street 1:60 RIVERSIDE BLVD APT 705
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10069-0209
Practice Address - Country:US
Practice Address - Phone:972-302-7061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0259861835P0018X, 207P00000X, 207RC0200X, 363A00000X
TXPA13511363A00000X
IL085007702363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine