Provider Demographics
NPI:1598437899
Name:DURANT, SIMONE DANIELLE (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:MS
First Name:SIMONE
Middle Name:DANIELLE
Last Name:DURANT
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2822 54TH AVE S # 213
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-4610
Mailing Address - Country:US
Mailing Address - Phone:727-265-0013
Mailing Address - Fax:
Practice Address - Street 1:6920 22ND AVE N STE 120
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-3920
Practice Address - Country:US
Practice Address - Phone:727-265-0013
Practice Address - Fax:727-289-3184
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1744P3200X, 224P00000X
FLCL290859224P00000X, 1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty