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General NPI Number Information
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NPI Number | 1669334827
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Entity Type | Organization
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Legal Business Name | BRAINLOGIX LAB, LLC
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Dates
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Enumeration Date | 11/25/2025
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 3801 AVALON PARK EAST BLVD STE 200
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City | ORLANDO
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State | FL
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Zip | 32828-4902
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Country | US
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Telephone | 321-461-3202
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Fax | 321-204-6855
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Provider Business Mailing Address
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Address Line | 13001 FOUNDERS SQUARE DR STE 200
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City | ORLANDO
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State | FL
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Zip | 32828-7708
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Country | US
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Telephone | 321-461-3202
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Fax | 321-204-6855
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Authorized Official
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Title or Position | CLINICAL NEUROPSYCHOLOGIST
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Name | DR. CHELSIE KAUILANI SIU-YIU SMYTH
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Credential | PSYD
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Telephone | 321-461-3202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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