1790058592 NPI number — MELODY A SIMPSON

Table of content: MELODY A SIMPSON (NPI 1790058592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790058592 NPI number — MELODY A SIMPSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMPSON
Provider First Name:
MELODY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1790058592
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 DOUGLAS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTAMONTE SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32714-2000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-035-9597
Provider Business Mailing Address Fax Number:
407-814-3863

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 DOUGLAS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTAMONTE SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32714-2000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-035-9597
Provider Business Practice Location Address Fax Number:
407-814-3863
Provider Enumeration Date:
02/10/2012

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: 171M00000X , 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: 003564600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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