Provider Demographics
NPI:1437446879
Name:SIMON, SHONDELL MALICIA (RN)
Entity Type:Individual
Prefix:
First Name:SHONDELL
Middle Name:MALICIA
Last Name:SIMON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 NEW YORK AVENUE
Mailing Address - Street 2:APT. 2C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1517
Mailing Address - Country:US
Mailing Address - Phone:347-866-0914
Mailing Address - Fax:
Practice Address - Street 1:169-37 144TH ROAD
Practice Address - Street 2:SWEET P HOME CARE, INC
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-5929
Practice Address - Country:US
Practice Address - Phone:718-978-7221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY639816-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse