Healthcare Provider Details

I. General information

NPI: 1689587875
Provider Name (Legal Business Name): MAYA SMITH-JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 N SWIFT RD
ADDISON IL
60101-6105
US

IV. Provider business mailing address

5960 NW 55TH LN
TAMARAC FL
33319-2419
US

V. Phone/Fax

Practice location:
  • Phone: 877-751-5783
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11042834
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: