Healthcare Provider Details

I. General information

NPI: 1629318639
Provider Name (Legal Business Name): MR. AARON HALL SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2013
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3790 DAIRY RD STE 108
MELBOURNE FL
32904-7630
US

IV. Provider business mailing address

3790 DAIRY RD STE 108
MELBOURNE FL
32904-7630
US

V. Phone/Fax

Practice location:
  • Phone: 386-310-0880
  • Fax:
Mailing address:
  • Phone: 386-310-0880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberRBT-26-541080
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number688366121
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: