Provider Demographics
NPI:1891161469
Name:SMITH, MANSFIELD
Entity Type:Individual
Prefix:MR
First Name:MANSFIELD
Middle Name:
Last Name:SMITH
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 1:15255 MAX LEGGETT PKWY
Mailing Address - Street 2:SUITE 5200
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-7273
Mailing Address - Country:US
Mailing Address - Phone:904-694-8511
Mailing Address - Fax:904-694-8514
Practice Address - Street 1:15255 MAX LEGGETT PKWY
Practice Address - Street 2:SUITE 5200
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-7273
Practice Address - Country:US
Practice Address - Phone:904-694-8511
Practice Address - Fax:904-694-8514
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS3718237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist