Provider Demographics
NPI:1811938806
Name:SMITH, AMY AMUNDSON (MD)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:AMUNDSON
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:AMUNDSON
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:92 W MILLER ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2032
Mailing Address - Country:US
Mailing Address - Phone:321-841-8588
Mailing Address - Fax:321-841-8560
Practice Address - Street 1:92 W MILLER ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2032
Practice Address - Country:US
Practice Address - Phone:321-841-8588
Practice Address - Fax:321-841-8560
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME928332080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA247513289AMedicaid
FL267133600Medicaid
FLME92833OtherMEDICAL LICENSE
FLME92833OtherMEDICAL LICENSE
FL267133600Medicaid
FL78999ZMedicare PIN