Provider Demographics
NPI:1144569815
Name:SMITH, GAYLE BRAZZI (MS, RD, LD/N)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:BRAZZI
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 KUHL AVE
Mailing Address - Street 2:ORMC CLINICAL NUTRITION MP#11
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2008
Mailing Address - Country:US
Mailing Address - Phone:321-841-8362
Mailing Address - Fax:407-649-6866
Practice Address - Street 1:1414 KUHL AVE
Practice Address - Street 2:ORMC CLINICAL NUTRITION MP#11
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2008
Practice Address - Country:US
Practice Address - Phone:321-841-8362
Practice Address - Fax:407-649-6866
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND1144133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered