Healthcare Provider Details

I. General information

NPI: 1194930198
Provider Name (Legal Business Name): YAMEN SMADI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 W GORE ST
ORLANDO FL
32806-1141
US

IV. Provider business mailing address

60 W GORE ST
ORLANDO FL
32806-1141
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-3338
  • Fax: 321-841-2170
Mailing address:
  • Phone: 321-841-3338
  • Fax: 321-841-2170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME117408
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301086030
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7325
License Number StateSD
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN18047
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberME117408
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: