1700474350 NPI number — MRS. EFFIE NYERAI SIMOYI APRN

Table of content: MRS. EFFIE NYERAI SIMOYI APRN (NPI 1700474350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700474350 NPI number — MRS. EFFIE NYERAI SIMOYI APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMOYI
Provider First Name:
EFFIE
Provider Middle Name:
NYERAI
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
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:
1700474350
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5607 NW 27TH AVE STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33142-2826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-805-1700
Provider Business Mailing Address Fax Number:
305-805-1715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 NW 71ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33150-3894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-637-6400
Provider Business Practice Location Address Fax Number:
305-636-5155
Provider Enumeration Date:
01/08/2021

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: 363LF0000X , with the licence number:  11010111 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 111910800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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