Wanda Ivelisse Smith, M.D.; MPH

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

ACN897 Issued in FL

Practice address

1301 W Colonial Dr
Orlando, FL 32804-7133

Phone

(407) 246-1946

Fax

(855) 895-5749

NPI assigned

Aug 29, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in PR, FL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sante Plus Medical Center

  • Family Medicine Physician
  • Fort Myers, FL
  • NPI 1639759475
  Medicare reassignment NPD
• Skills 4 You Florida, LLC

  • General Practice Physician
  • Clermont, FL
  • NPI 1740630946

  Family Medicine

  NPD
• Sante Plus Medical Center

  • Clinic/Center
  • Immokalee, FL
  • NPI 1407514904
  NPD (past)

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

{
    "created_epoch": "1188345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1972797348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4440 FRUITVILLE RD",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342321926",
            "telephone_number": "941-366-0134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 W COLONIAL DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328047133",
            "telephone_number": "407-246-1946",
            "fax_number": "855-895-5749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "WANDA",
        "middle_name": "IVELISSE",
        "name_prefix": "Dr.",
        "credential": "M.D.; MPH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-29",
        "last_updated": "2023-03-07",
        "certification_date": "2021-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ACN897",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PR",
            "license": "7586",
            "primary": false
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "PR",
            "license": "MPH",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ACN897",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DIPLOMATE AMERICAN BOARD OF SEXOLOGY",
            "identifier": "2542",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "020108900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD LICENSE",
            "identifier": "XX86",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD LICENSE",
            "identifier": "ACN 897",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tracy Cornelia Smith, APRN
• Tracy D Smith, PH.D.
• Tricia Smith
• Valerie Plante Smith, PT
• Vicky Arlene Smith, APRN, WHNP-BC
• William Russell Smith
• Wiston Smith
• Yvonne Smith, RN
• Zachary Lee Smith, MD
• Emily Smithies, PA-C

• General Practice Physician in Orlando, FL
• Providers in Orlando, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.