Provider Demographics
NPI:1043435654
Name:SMITH, WAYNE LEE (BCHIS)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:M
Credentials:BCHIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 490065
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-0065
Mailing Address - Country:US
Mailing Address - Phone:321-784-2668
Mailing Address - Fax:321-784-6048
Practice Address - Street 1:410 W COCOA BEACH CSWY
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-3534
Practice Address - Country:US
Practice Address - Phone:321-784-2668
Practice Address - Fax:321-784-6048
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS1093237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist