Individual ProviderMalissa SmithLicensed Practical NurseNursing Service ProvidersPractice Address365 Broadway, Amityville, NY 11701-2716(631) 608-8523PECOS EnrollmentBased on the most recent information from CMS, provider Malissa Smith does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:43 AM.Profile DetailsProvider ID1033668942Provider TypeIndividualFull NameSmith, MalissaGenderFemaleSole ProprietorYesEnumeration Date10/4/2016Last Updated10/4/2016Contact InformationPractice LocationPractice Address365 Broadway, Amityville, NY 11701-2716Phone(631) 608-8523FaxUnlisted FaxMailing LocationMailing Address365 Broadway, Amityville, NY 11701-2716Phone(631) 608-8523FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode164W00000XPrimaryDescriptionLicensed Practical NurseNursing Service ProvidersLicense308821New York