Provider Demographics
NPI:1851911309
Name:SIMON, SHARONDA MARIE
Entity Type:Individual
Prefix:
First Name:SHARONDA
Middle Name:MARIE
Last Name:SIMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1864 MIDDLE AVE APT J3
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-7868
Mailing Address - Country:US
Mailing Address - Phone:216-468-2049
Mailing Address - Fax:
Practice Address - Street 1:1864 MIDDLE AVE APT J3
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-7868
Practice Address - Country:US
Practice Address - Phone:216-468-2049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty