Provider Demographics
NPI:1689707283
Name:SIMON, SHYNI A (CRNP)
Entity Type:Individual
Prefix:MS
First Name:SHYNI
Middle Name:A
Last Name:SIMON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64294
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4294
Mailing Address - Country:US
Mailing Address - Phone:443-481-6482
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2000 MEDICAL PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3742
Practice Address - Country:US
Practice Address - Phone:443-481-5300
Practice Address - Fax:443-481-6705
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR153217207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
91145401OtherBCBS MD
MD91145403OtherBCBS
MD91145404OtherBCBS
DCV8740004OtherBCBS
MD145724700OtherFEDERAL WORKMAN'S COMP
MD325633OtherAMERIGROUP
58860011OtherBCBS DC
DCV8380005OtherBCBS
911454-03OtherBCBS MARYLAND
MD412648300Medicaid
6301091OtherAETNA HMO
9678143OtherAETNA PPO
DCV8080005OtherBCBS
171268ZFQCMedicare PIN
MD91145403OtherBCBS
91145401OtherBCBS MD
58860011OtherBCBS DC
172268YBL9Medicare PIN
MD145724700OtherFEDERAL WORKMAN'S COMP
DCV8080005OtherBCBS