Provider Demographics
NPI:1649233610
Name:SIMMONS, SHARONELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARONELLE
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3337 N MILLER RD
Mailing Address - Street 2:STE 103
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6496
Mailing Address - Country:US
Mailing Address - Phone:480-949-1182
Mailing Address - Fax:
Practice Address - Street 1:3337 N MILLER RD
Practice Address - Street 2:STE 103
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6496
Practice Address - Country:US
Practice Address - Phone:480-949-1182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0071880OtherBCBS OF AZ
AZ03D0529742OtherCLIA
AZ2569417OtherAETNA
AZ1Z7430OtherHEALTHNET INS. CO.
AZ860465646OtherALL OTHER INS CO.
AZ2569417OtherAETNA