Provider Demographics
NPI:1134598857
Name:SIMMONDS, SHAVONE (PA-C)
Entity type:Individual
Prefix:MS
First Name:SHAVONE
Middle Name:
Last Name:SIMMONDS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 TOUCHTON RD
Mailing Address - Street 2:APT. #638
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-8296
Mailing Address - Country:US
Mailing Address - Phone:571-521-9811
Mailing Address - Fax:
Practice Address - Street 1:1887 KINGSLEY AVE
Practice Address - Street 2:SUITE 1900
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4416
Practice Address - Country:US
Practice Address - Phone:904-272-9981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9108356363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical