1649233610 NPI number — DR. SHARONELLE SIMMONS M.D.

Table of content: DR. SHARONELLE SIMMONS M.D. (NPI 1649233610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649233610 NPI number — DR. SHARONELLE SIMMONS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMMONS
Provider First Name:
SHARONELLE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1649233610
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3337 N MILLER RD
Provider Second Line Business Mailing Address:
STE 103
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85251-6496
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-949-1182
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3337 N MILLER RD
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85251-6496
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-949-1182
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2006

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:  13628 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AZ0071880 . This is a "BCBS OF AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 03D0529742 . This is a "CLIA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 2569417 . This is a "AETNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1Z7430 . This is a "HEALTHNET INS. CO." identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 860465646 . This is a "ALL OTHER INS CO." identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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