Provider Demographics
NPI:1205287976
Name:SIMON, TENISHA (NP)
Entity type:Individual
Prefix:
First Name:TENISHA
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 PARKVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19012-1428
Mailing Address - Country:US
Mailing Address - Phone:347-291-1144
Mailing Address - Fax:754-218-0988
Practice Address - Street 1:175 PEARL ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-7508
Practice Address - Country:US
Practice Address - Phone:347-291-1144
Practice Address - Fax:754-218-0988
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF402006363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health