Healthcare Provider Details

I. General information

NPI: 1235404179
Provider Name (Legal Business Name): DAVID S SMILEY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2012
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16877 E COLONIAL DR STE 327
ORLANDO FL
32820-1910
US

IV. Provider business mailing address

16877 E COLONIAL DR STE 327
ORLANDO FL
32820-1910
US

V. Phone/Fax

Practice location:
  • Phone: 858-876-4539
  • Fax:
Mailing address:
  • Phone: 858-876-4539
  • Fax: 407-704-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY5007
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPY5007
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY5007
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: