Provider Demographics
NPI:1407519432
Name:SIMONI, CHELSEY
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:
Last Name:SIMONI
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 1:306 THAYER ST UNIT 2694
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-7716
Mailing Address - Country:US
Mailing Address - Phone:202-599-6477
Mailing Address - Fax:
Practice Address - Street 1:25 CEDAR RD
Practice Address - Street 2:
Practice Address - City:N ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02763-1107
Practice Address - Country:US
Practice Address - Phone:401-965-7097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-17
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2331408163WE0003X, 171000000X, 171M00000X, 2083P0500X, 364SC1501X
RIRN62862171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No171000000XOther Service ProvidersMilitary Health Care Provider
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine