Provider Demographics
NPI:1497768956
Name:SIMON, SHERRY A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:A
Last Name:SIMON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4862 SPRINGBROOK DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1182
Mailing Address - Country:US
Mailing Address - Phone:419-885-4121
Mailing Address - Fax:419-885-6121
Practice Address - Street 1:6400 MONROE ST
Practice Address - Street 2:SUITE E
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-1453
Practice Address - Country:US
Practice Address - Phone:419-885-4121
Practice Address - Fax:419-885-6121
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4728103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCP14426Medicare PIN