Provider Demographics
NPI:1861013732
Name:SIMPSON, SHONTAY
Entity Type:Individual
Prefix:MRS
First Name:SHONTAY
Middle Name:
Last Name:SIMPSON
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 1:37 SAINT ANTHONY LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-6720
Mailing Address - Country:US
Mailing Address - Phone:314-599-0024
Mailing Address - Fax:314-561-7489
Practice Address - Street 1:37 SAINT ANTHONY LN
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-6720
Practice Address - Country:US
Practice Address - Phone:314-599-0024
Practice Address - Fax:314-561-7489
Is Sole Proprietor?:No
Enumeration Date:2020-05-02
Last Update Date:2020-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator