Provider Demographics
NPI:1003207440
Name:SIM, WINNIE
Entity Type:Individual
Prefix:MS
First Name:WINNIE
Middle Name:
Last Name:SIM
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:WAI CHUEN
Other - Middle Name:
Other - Last Name:SIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3618 203RD ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1124
Mailing Address - Country:US
Mailing Address - Phone:646-942-7240
Mailing Address - Fax:
Practice Address - Street 1:3618 203RD ST
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-1124
Practice Address - Country:US
Practice Address - Phone:646-942-7240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1781429174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist