Provider Demographics
NPI:1285473769
Name:SMEDLEY, BRETT KELSO
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:KELSO
Last Name:SMEDLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43596 MERCHANT MILL TER
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8228
Mailing Address - Country:US
Mailing Address - Phone:571-455-2676
Mailing Address - Fax:
Practice Address - Street 1:44045 RIVERSIDE PKWY STE N112
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-5101
Practice Address - Country:US
Practice Address - Phone:703-858-6020
Practice Address - Fax:703-858-6007
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0203020897390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program