Healthcare Provider Details

I. General information

NPI: 1629995154
Provider Name (Legal Business Name): KAALA MONIQUE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10006 WELLNESS WAY STE 130
ORLANDO FL
32832-7150
US

IV. Provider business mailing address

8097 POINCIANA BLVD APT 205
ORLANDO FL
32821-5663
US

V. Phone/Fax

Practice location:
  • Phone: 407-250-4062
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP4773
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: