Provider Demographics
NPI:1053509943
Name:SIMS, BRENDA FAYE (CPT, CMA)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:FAYE
Last Name:SIMS
Suffix:
Gender:F
Credentials:CPT, CMA
Other - Prefix:MS
Other - First Name:BRENDA
Other - Middle Name:FAYE
Other - Last Name:BURRISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7157 STAG HORN PATH
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5224
Mailing Address - Country:US
Mailing Address - Phone:443-850-9278
Mailing Address - Fax:410-381-5007
Practice Address - Street 1:6521 ARLINGTON BLVD STE 103
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3016
Practice Address - Country:US
Practice Address - Phone:443-850-9278
Practice Address - Fax:410-384-4256
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X
MD36119494246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No291U00000XLaboratoriesClinical Medical Laboratory