Provider Demographics
NPI:1073744520
Name:SMITHSON, SHAUN DANE VILLIERS
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:DANE VILLIERS
Last Name:SMITHSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-9800
Mailing Address - Country:US
Mailing Address - Phone:305-571-0620
Mailing Address - Fax:305-576-8099
Practice Address - Street 1:21097 NE 27TH CT
Practice Address - Street 2:SUITE 100
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1204
Practice Address - Country:US
Practice Address - Phone:305-792-0012
Practice Address - Fax:305-792-0030
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME128642207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology