Provider Demographics
NPI:1790105369
Name:SIMPSON, MONIQUE ELISE (MD)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:ELISE
Last Name:SIMPSON
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 1:1070 MONTGOMERY RD STE 2198
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7420
Mailing Address - Country:US
Mailing Address - Phone:407-504-7121
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1699
Practice Address - Country:US
Practice Address - Phone:570-888-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1393162084P0800X, 2084P0804X
NMMD2020-08822084P0800X, 2084P0804X
NJ25MA109906002084P0800X, 2084P0804X
VT042.0015057-COVID2084P0800X
NY3154152084P0800X, 2084P0804X
CAC1948462084P0800X
PAMD4630442084P0804X, 2084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM62673246Medicaid