Vita Sana Lifestyle Medicine

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Legal business name

VITA SANA LIFESTYLE MEDICINE

Practice address

425 W Colonial Dr Ste 101
PMB 451
Orlando, FL 32804-6863

Phone

(407) 476-6040

NPI assigned

Jan 31, 2026

Last updated

Jan 31, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Russell Smith, PA-CNPI 1023557402

Title

Owner/Provider

Phone

(978) 895-0270

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Russell Smith, PA-C

  • Physician Assistant
  • Orlando, FL
  • NPI 1023557402

  Medical

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1769817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769817600000",
    "number": "1225988041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 W COLONIAL DR STE 101",
            "address_2": "PMB 451",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328046863",
            "telephone_number": "407-476-6040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 W COLONIAL DR STE 101",
            "address_2": "PMB 451",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328046863",
            "telephone_number": "407-476-6040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITA SANA LIFESTYLE MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-01-31",
        "last_updated": "2026-01-31",
        "certification_date": "2026-01-30",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "978-895-0270",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Physician Assistant in Orlando, FL
• Providers in Orlando, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.