Provider Demographics
NPI:1790555308
Name:SMITH, LYNDSAY (AA)
Entity Type:Individual
Prefix:
First Name:LYNDSAY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 N STONE ST STE 206
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-3208
Mailing Address - Country:US
Mailing Address - Phone:386-736-7192
Mailing Address - Fax:386-736-8520
Practice Address - Street 1:844 N STONE ST STE 206
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3208
Practice Address - Country:US
Practice Address - Phone:386-736-7192
Practice Address - Fax:386-736-8520
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAI5502355A2700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology Assistant