Provider Demographics
NPI:1821383571
Name:FAHIMA, SIMONE ASHLEY (MA)
Entity Type:Individual
Prefix:MRS
First Name:SIMONE
Middle Name:ASHLEY
Last Name:FAHIMA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 GOLDEN ISLES DR
Mailing Address - Street 2:#101
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-7563
Mailing Address - Country:US
Mailing Address - Phone:954-695-0727
Mailing Address - Fax:
Practice Address - Street 1:455 GOLDEN ISLES DR
Practice Address - Street 2:#101
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-7563
Practice Address - Country:US
Practice Address - Phone:954-695-0727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11974235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004034300Medicaid