Provider Demographics
NPI:1417383159
Name:SIMPSON, SHIRA R (MMS, PA-C)
Entity Type:Individual
Prefix:MS
First Name:SHIRA
Middle Name:R
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:SHIRA
Other - Middle Name:R
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:300 PASTEUR DR
Mailing Address - Street 2:BOSWELL CLINIC A11, ROOM A104
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-2203
Mailing Address - Country:US
Mailing Address - Phone:650-723-6961
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:BOSWELL CLINIC A11, ROOM A104
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-2203
Practice Address - Country:US
Practice Address - Phone:650-723-6961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51869363AM0700X
CAPA51869367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ856339Medicaid