Shondra L Smith, MD Dermatology & Advanced Aesthetics, LLC
Organization Active NPI Dermatology Physician · Lake Charles, LA
NPI 1447248166 · NPPES record last updated May 4, 2026
Key facts
- NPI
- 1447248166
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- SHONDRA L SMITH, MD DERMATOLOGY & ADVANCED AESTHETICS, LLC
- Practice address
- 3635 Nelson Road
Lake Charles, LA 70605-0000 - Phone
- (337) 477-0011
- Fax
- (337) 477-0010
- NPI assigned
- Oct 6, 2005
- Organization subpart
- No
Authorized official
- Name
- Dr. Shondra L. Smith, MD
- Title
- Owner/MD
- Phone
- (337) 477-0011
Practitioners 7
-
Jill Conner, N.P.
-
John Paul Miller, MD
-
Shondra L. Smith, MD
-
Savannah Guidry Burnett, PA-C
-
Cindi Ann Reed, PHARMD
-
Randall Scott Juleff, M.D.
-
Charles Scott Norris, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 19D1065088 | Dermatology & Advanced Aesthetics | Certificate of waiver | Feb 20, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041118000674 | LA | Part B Supplier - Clinic/Group Practice | 9436113487 |
Receives reassigned benefits from 4 practitioners Practice locations: Lake Charles, LA |
National Provider Directory
Locations
3635 Nelson Rd
Lake Charles, LA 70605
Phone (337) 477-0011
1800 Ryan St
Ste 106
Lake Charles, LA 70601
Phone (318) 494-5599
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | Yes |
Addresses
Primary practice location
3635 Nelson Road
Lake Charles, LA 70605-0000
Mailing address
3635 Nelson Rd
Lake Charles, LA 70605-1213
Phone (337) 477-0011
Other names
- Dermatology and Advanced Aesthetics, LLC
Other providers in Lake Charles, LA
- Shianne Syed, M. Ed, LPC, NCC, LLC
- Richard Thomas Shimer
- Shantell Shinnette
- Amanda Shoemake
- Shonda Wigs Refining Boutique LLC.
- Courtney Michelle Short-Prudhomme
- Morgan Rae Short
- Ronald Michael Short
- Cynthia B Shrewsberry
- Judith A Shuff
All providers in Lake Charles, LA · Dermatology Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 4, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.