MEDICARE: NATASHA SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1558713206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATASHA SMITH

Provider Business Mailing Address
First Line	:	486 N PIN OAK PL
Second Line	:	APT. 316
City	:	LONGWOOD
State	:	FL
Zip	:	32779-6179
Country	:	US
Telephone Number	:	407-725-8558
Fax Number	:

Provider Business Practice Location Address
First Line	:	3708 CONWAY RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-7608
Country	:	US
Telephone Number	:	407-376-6687
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2016
Last Update Date	:	03/28/2017

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Directions to “ NATASHA SMITH ” Practice Location

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