Provider Demographics
NPI:1598883464
Name:SMITH, PATRICIA PAMELA (EDD, RD, LDN)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:PAMELA
Last Name:SMITH
Suffix:
Gender:F
Credentials:EDD, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 NATCHEZ TRACE BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-9041
Mailing Address - Country:US
Mailing Address - Phone:407-299-3872
Mailing Address - Fax:
Practice Address - Street 1:1806 NATCHEZ TRACE BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-9041
Practice Address - Country:US
Practice Address - Phone:407-299-3872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL001188133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered