Provider Demographics
NPI:1730366626
Name:SMART-MACKEY, PAULETTE ANDREA (MD)
Entity type:Individual
Prefix:DR
First Name:PAULETTE
Middle Name:ANDREA
Last Name:SMART-MACKEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAULETTE
Other - Middle Name:A
Other - Last Name:SMART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 561405
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32856-1405
Mailing Address - Country:US
Mailing Address - Phone:407-858-1371
Mailing Address - Fax:407-855-0762
Practice Address - Street 1:25 W CRYSTAL LAKE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4475
Practice Address - Country:US
Practice Address - Phone:407-858-1371
Practice Address - Fax:407-855-0762
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2010-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0072680208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252661100Medicaid
FL41934AMedicare PIN
FL252661100Medicaid