Healthcare Provider Details

I. General information

NPI: 1548130768
Provider Name (Legal Business Name): ONE MIAMI MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2025
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 BISCAYNE BLVD STE 680
MIAMI FL
33137-3244
US

IV. Provider business mailing address

685 NE 59TH ST
MIAMI FL
33137-2362
US

V. Phone/Fax

Practice location:
  • Phone: 786-529-6172
  • Fax:
Mailing address:
  • Phone: 786-529-6172
  • Fax: 305-506-4387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAUN DANE VILLIERS SMITHSON
Title or Position: PRESIDENT
Credential: MD
Phone: 832-799-4493