Provider Demographics
NPI:1578980751
Name:SIMOYI, MAZVITA ETHEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MAZVITA
Middle Name:ETHEL
Last Name:SIMOYI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:425 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-4239
Mailing Address - Country:US
Mailing Address - Phone:844-634-3627
Mailing Address - Fax:863-676-3621
Practice Address - Street 1:425 S 11TH ST
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4239
Practice Address - Country:US
Practice Address - Phone:844-634-3627
Practice Address - Fax:863-676-3621
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME140906208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery