Provider Demographics
NPI:1871462499
Name:SIMMONS, AUBREY C
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:C
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 1:715 SUMMERS PL
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23702-1137
Mailing Address - Country:US
Mailing Address - Phone:347-677-3352
Mailing Address - Fax:
Practice Address - Street 1:715 SUMMERS PL
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23702-1137
Practice Address - Country:US
Practice Address - Phone:347-677-3352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-03
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYZ7Z6R6B3246Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyGroup - Single Specialty