Smith, Wanda Ivelisse
Smith, Wanda Ivelisse is an sole proprietor health care provider with primary practice located at 1301 W Colonial Dr , Orlando FL 32804-7133. She recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Public Health & General Preventive Medicine, Allopathic & Osteopathic Physicians / General Practice. Allopathic & Osteopathic Physicians / General Practice is her primary health care specialty. Smith, Wanda Ivelisse can be contacted via phone (407) 246-1946.Contact Information
Primary practice address
1301 W Colonial Dr
Orlando FL 32804-7133
Phone: (407) 246-1946
Fax: (855) 895-5749
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | ACN897 | Florida |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 7586 | Puerto Rico |
| Allopathic & Osteopathic Physicians / Public Health & General Preventive Medicine | 2083P0901X | MPH | Puerto Rico |
| Allopathic & Osteopathic Physicians / General Practice | 208D00000X | ACN897 | Florida |
Profile Details
| NPI number | 1972797348 |
|---|---|
| LBN Legal business name | Smith, Wanda Ivelisse |
| Credentials | M.D.; MPH |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 29th, 2007 |
| Last updated | Mar 7th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1972797348 | NPPES |
| Florida | Other | 2542 | DIPLOMATE AMERICAN BOARD OF SEXOLOGY |
| Florida | MEDICAID | 020108900 | DIPLOMATE AMERICAN BOARD OF SEXOLOGY |
| Florida | Other | XX86 | DIPLOMATE AMERICAN BOARD OF SEXOLOGY |
| Florida | Other | ACN 897 | DIPLOMATE AMERICAN BOARD OF SEXOLOGY |
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