MEDICARE: BRANDIE SMITH AU.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	231H00000X	Audiologist

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	:	1972161388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDIE SMITH AU.D.

Provider Business Mailing Address
First Line	:	504 S ARMENIA AVE UNIT 1314
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3390
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1430 66TH ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-5504
Country	:	US
Telephone Number	:	727-343-3019
Fax Number	:

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

Provider Enumeration Date	:	05/31/2019
Last Update Date	:	05/31/2019

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