Healthcare Provider Details

I. General information

NPI: 1821343138
Provider Name (Legal Business Name): DANIELLE L SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8075 SW HIGHWAY 200 UNIT 106
OCALA FL
34481-7823
US

IV. Provider business mailing address

PO BOX 1425
CAROL STREAM IL
60132-1425
US

V. Phone/Fax

Practice location:
  • Phone: 351-291-0152
  • Fax:
Mailing address:
  • Phone: 561-678-3394
  • Fax: 352-753-6415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS4829
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: