Healthcare Provider Details

I. General information

NPI: 1225651425
Provider Name (Legal Business Name): CHELSIE K SMYTH PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 AVALON PARK EAST BLVD STE 200
ORLANDO FL
32828-4902
US

IV. Provider business mailing address

3801 AVALON PARK EAST BLVD STE 200
ORLANDO FL
32828-4902
US

V. Phone/Fax

Practice location:
  • Phone: 321-461-3202
  • Fax: 321-204-6855
Mailing address:
  • Phone: 321-461-3202
  • Fax: 321-204-6855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY11674
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: