1689707283 NPI number — MS. SHYNI A SIMON CRNP

Table of content: MS. SHYNI A SIMON CRNP (NPI 1689707283)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689707283 NPI number — MS. SHYNI A SIMON CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMON
Provider First Name:
SHYNI
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689707283
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 64294
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21264-4294
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-481-6482
Provider Business Mailing Address Fax Number:
443-481-6515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 MEDICAL PKWY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-3742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-481-5300
Provider Business Practice Location Address Fax Number:
443-481-6705
Provider Enumeration Date:
03/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  R153217 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 91145401 . This is a "BCBS MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 91145403 . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 91145404 . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: V8740004 . This is a "BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 145724700 . This is a "FEDERAL WORKMAN'S COMP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 325633 . This is a "AMERIGROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 58860011 . This is a "BCBS DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: V8380005 . This is a "BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 911454-03 . This is a "BCBS MARYLAND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 412648300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6301091 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9678143 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: V8080005 . This is a "BCBS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".