Individual
SALLY M SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2855 5TH AVE N, ST PETERSBURG, FL 33713-6701
(727) 323-2727
(727) 327-8101
Mailing address
2855 5TH AVE N, ST PETERSBURG, FL 33713-6701
(727) 323-2727
(727) 327-8101
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME0057818
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
063707600
—
FL
01
—
11519
BCBS
FL
Enumeration date
11/14/2005
Last updated
12/17/2014
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