Provider Demographics
NPI:1831892025
Name:SIMELUS, JEAN SIMELUS
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:SIMELUS
Last Name:SIMELUS
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 1:190 MAUDEHELEN ST
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-1706
Mailing Address - Country:US
Mailing Address - Phone:407-887-6556
Mailing Address - Fax:866-861-1819
Practice Address - Street 1:650 ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5460
Practice Address - Country:US
Practice Address - Phone:407-887-6556
Practice Address - Fax:866-861-1819
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver