Provider Demographics
NPI:1952832198
Name:SIMPSON, SHANTA
Entity Type:Individual
Prefix:MISS
First Name:SHANTA
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 1:3104 GRAND PAVILION DR
Mailing Address - Street 2:APT 201
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3395
Mailing Address - Country:US
Mailing Address - Phone:813-731-9488
Mailing Address - Fax:
Practice Address - Street 1:4217 TRUMPWORTH CT
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-8494
Practice Address - Country:US
Practice Address - Phone:813-731-9488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist