Provider Demographics
NPI:1295057354
Name:SHARONELLE SIMMONS, M.D
Entity type:Organization
Organization Name:SHARONELLE SIMMONS, M.D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARONELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-949-1182
Mailing Address - Street 1:6200 S MCCLINTOCK DR STE 104
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3268
Mailing Address - Country:US
Mailing Address - Phone:480-388-3666
Mailing Address - Fax:480-388-3667
Practice Address - Street 1:6200 S MCCLINTOCK DR STE 104
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3268
Practice Address - Country:US
Practice Address - Phone:480-388-3666
Practice Address - Fax:480-388-3667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363LW0102X
AZ13628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2569417OtherAETNA
1Z7430OtherHEALTHNET
AZAZ0071880OtherBC/BS OF AZ.
AZ2569417OtherAETNA