Provider Demographics
NPI:1487636379
Name:SMITH, DELIA A (MD)
Entity Type:Individual
Prefix:
First Name:DELIA
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 PELICAN DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32951-3736
Mailing Address - Country:US
Mailing Address - Phone:601-421-0091
Mailing Address - Fax:
Practice Address - Street 1:1264 MALABAR RD SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2556
Practice Address - Country:US
Practice Address - Phone:321-434-1486
Practice Address - Fax:321-434-5295
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME147647207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRU186OtherHFMG MA
FL108675700Medicaid
550033371OtherRAILROAD MEDICARE
550033371OtherRAILROAD MEDICARE
H32492Medicare UPIN