Provider Demographics
NPI:1003218652
Name:SIMMONS, SHELIA L
Entity Type:Individual
Prefix:
First Name:SHELIA
Middle Name:L
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELIA
Other - Middle Name:L
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:67 AZALEA TRL
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:FL
Mailing Address - Zip Code:32333-5135
Mailing Address - Country:US
Mailing Address - Phone:850-212-5612
Mailing Address - Fax:
Practice Address - Street 1:67 AZALEA TRL
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:FL
Practice Address - Zip Code:32333-5135
Practice Address - Country:US
Practice Address - Phone:850-212-5612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013402800Medicaid