Organization
VITA SANA LIFESTYLE MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL SMITH PA-C (OWNER/PROVIDER)
(978) 895-0270
Entity
Organization
Contact information
Practice address
425 W COLONIAL DR STE 101, PMB 451, ORLANDO, FL 32804-6863
(407) 476-6040
Mailing address
425 W COLONIAL DR STE 101, PMB 451, ORLANDO, FL 32804-6863
(407) 476-6040
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
01/31/2026
Last updated
01/31/2026
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