MEDICARE: MS. SHANA RENEE SMITH MS

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	235Z00000X	Speech-Language Pathologist	SA11526	FL

General Provider Information

NPI Number	:	1245547611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHANA RENEE SMITH MS

Provider Business Mailing Address
First Line	:	10059 IVERSON DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32832-5617
Country	:	US
Telephone Number	:	856-534-9875
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 E COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-5227
Country	:	US
Telephone Number	:	407-898-5060
Fax Number	:

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

Provider Enumeration Date	:	09/08/2010
Last Update Date	:	09/08/2023

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Directions to “ MS. SHANA RENEE SMITH MS” Practice Location

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