Provider Demographics
NPI:1932171196
Name:SMITH, LESLEY JACQUELINE (MD)
Entity type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:JACQUELINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 NW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1005
Mailing Address - Country:US
Mailing Address - Phone:305-243-3166
Mailing Address - Fax:
Practice Address - Street 1:1601 NW 12TH AVE
Practice Address - Street 2:MAILMAN CENTER 3005A, DIV PEDS GI & NUTRITON
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-243-6426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0023272080P0206X
FLME982352080T0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080T0004XAllopathic & Osteopathic PhysiciansPediatricsPediatric Transplant Hepatology
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02635203Medicaid
NYL29206Medicare UPIN