Provider Demographics
NPI:1376571356
Name:SIMON, MICHELE BETH (AUD, FAAA)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:BETH
Last Name:SIMON
Suffix:
Gender:F
Credentials:AUD, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S UNION ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-3676
Mailing Address - Country:US
Mailing Address - Phone:716-379-8356
Mailing Address - Fax:716-379-8361
Practice Address - Street 1:130 S UNION ST
Practice Address - Street 2:SUITE 1
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-3676
Practice Address - Country:US
Practice Address - Phone:716-379-8356
Practice Address - Fax:716-379-8361
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000761-1237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
040426004078OtherFIDELIS
161516529OtherRAILROAD MEDICARE
9209988OtherINDEPENDENT HEALTH
NY0005760395OtherCOMMUNITY BLUE/ BCBS
PA225284OtherBLUE CROSS BLUE SHIELD
00020283801OtherUNIVERA
NY01616600Medicaid
PA225284OtherBLUE CROSS BLUE SHIELD