MEDICARE: MR. AARON HALL SMITH

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	103K00000X	Behavior Analyst	RBT-26-541080	FL
2	174400000X	Specialist	688366121	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	688366121	OTHER	NY	NYS TEACHERS CERTIFICATION

General Provider Information

NPI Number	:	1629318639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AARON HALL SMITH

Provider Business Mailing Address
First Line	:	3790 DAIRY RD STE 108
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32904-7630
Country	:	US
Telephone Number	:	386-310-0880
Fax Number	:

Provider Business Practice Location Address
First Line	:	3790 DAIRY RD STE 108
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32904-7630
Country	:	US
Telephone Number	:	386-310-0880
Fax Number	:

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

Provider Enumeration Date	:	02/27/2013
Last Update Date	:	06/19/2026

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