Provider Demographics
NPI:1700457611
Name:SIMMONS, SHALOM CHARISSE (AGACNP-BC MSN, RN)
Entity Type:Individual
Prefix:MS
First Name:SHALOM
Middle Name:CHARISSE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:AGACNP-BC MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 MACDONOUGH ST APT 4R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-2517
Mailing Address - Country:US
Mailing Address - Phone:718-541-4132
Mailing Address - Fax:
Practice Address - Street 1:129 MACDONOUGH ST APT 4R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-2517
Practice Address - Country:US
Practice Address - Phone:718-541-4132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY431902363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care