Healthcare Provider Details

I. General information

NPI: 1497055313
Provider Name (Legal Business Name): LISA C. SMEALLIE AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 WISCONSIN AVE NW SUITE 202
WASHINGTON DC
20007-2265
US

IV. Provider business mailing address

PO BOX 418283
BOSTON MA
02241-8283
US

V. Phone/Fax

Practice location:
  • Phone: 202-944-5300
  • Fax: 877-754-5490
Mailing address:
  • Phone: 703-558-1544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number000064
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: