Individual
DR. WANDA IVELISSE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.; MPH
Contact information
Practice address
1301 W COLONIAL DR, ORLANDO, FL 32804-7133
(407) 246-1946
(855) 895-5749
Mailing address
4440 FRUITVILLE RD, SARASOTA, FL 34232-1926
(941) 366-0134
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
7586
PR
207Q00000X
Family Medicine Physician
ACN897
FL
2083P0901X
Public Health & General Preventive Medicine Physician
MPH
PR
208D00000X
General Practice Physician
Primary
ACN897
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020108900
—
FL
01
—
2542
DIPLOMATE AMERICAN BOARD OF SEXOLOGY
FL
01
—
ACN 897
MD LICENSE
FL
01
—
XX86
MD LICENSE
PR
Enumeration date
08/29/2007
Last updated
03/07/2023
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