Provider Demographics
NPI:1003576786
Name:SIMANO, TONYA
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:SIMANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1964 ASHLEY RIVER RD # 8090B
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29416-1400
Mailing Address - Country:US
Mailing Address - Phone:813-455-7513
Mailing Address - Fax:888-808-4249
Practice Address - Street 1:1964 ASHLEY RIVER RD # 8090B
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29416-1400
Practice Address - Country:US
Practice Address - Phone:813-455-7513
Practice Address - Fax:888-808-4249
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician