Provider Demographics
NPI:1538321997
Name:SIMELA, TANASHA (DO)
Entity Type:Individual
Prefix:DR
First Name:TANASHA
Middle Name:
Last Name:SIMELA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 RIVER RD STE 32-114
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1171
Mailing Address - Country:US
Mailing Address - Phone:844-433-7636
Mailing Address - Fax:
Practice Address - Street 1:1065 SOUTHERN BOULEVARD
Practice Address - Street 2:MEDICAL AFFAIRS
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459
Practice Address - Country:US
Practice Address - Phone:718-589-2440
Practice Address - Fax:718-991-4516
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10158200207N00000X
NY290569207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology