Provider Demographics
NPI:1235772526
Name:SIMMONS, SHENA (HAIR REPLACEMENT SPE)
Entity Type:Individual
Prefix:
First Name:SHENA
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:HAIR REPLACEMENT SPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 WARFIELD WAY UNIT D
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-3645
Mailing Address - Country:US
Mailing Address - Phone:415-867-0432
Mailing Address - Fax:
Practice Address - Street 1:2232 WARFIELD WAY UNIT D
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-3645
Practice Address - Country:US
Practice Address - Phone:415-867-0432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-20
Last Update Date:2019-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management