MEDICARE: DR. DAVID S SMILEY PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY5007	FL
2	103TF0200X	Forensic Psychologist	PY5007	FL
3	103TC0700X	Clinical Psychologist	PY5007	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235404179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID S SMILEY PH.D.

Provider Business Mailing Address
First Line	:	16877 E COLONIAL DR STE 327
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32820-1910
Country	:	US
Telephone Number	:	858-876-4539
Fax Number	:	407-704-1787

Provider Business Practice Location Address
First Line	:	16877 E COLONIAL DR STE 327
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32820-1910
Country	:	US
Telephone Number	:	858-876-4539
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2012
Last Update Date	:	06/16/2023

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