Provider Demographics
NPI:1770272841
Name:SIMMONS, JAYLEN M
Entity type:Individual
Prefix:
First Name:JAYLEN
Middle Name:M
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5308 PORTSMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-3429
Mailing Address - Country:US
Mailing Address - Phone:434-962-7213
Mailing Address - Fax:
Practice Address - Street 1:5308 PORTSMOUTH RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-3429
Practice Address - Country:US
Practice Address - Phone:434-962-7213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer