MEDICARE: INNER WAY LLC

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1396475562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER WAY LLC

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	:	407-704-1787

Authorized Official
Title or Position	:	OWNER/PSYCHOLOGIST
Name	:	DR. DAVID S SMILEY
Credential	:	PHD
Telephone Number	:	858-876-4539

Provider Enumeration Date	:	06/12/2022
Last Update Date	:	06/16/2023

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