Provider Demographics
NPI:1184346827
Name:SMITH, KIMANI LESHAUN
Entity type:Individual
Prefix:
First Name:KIMANI
Middle Name:LESHAUN
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6840 PEMBROKE RD APT 102
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-2680
Mailing Address - Country:US
Mailing Address - Phone:941-623-3040
Mailing Address - Fax:
Practice Address - Street 1:6840 PEMBROKE RD APT 102
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-2680
Practice Address - Country:US
Practice Address - Phone:941-623-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCL12852851744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty