Provider Demographics
NPI:1881327930
Name:SIMURO, ANNELIE FERNANDA
Entity type:Individual
Prefix:
First Name:ANNELIE
Middle Name:FERNANDA
Last Name:SIMURO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 SANDHURST DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-6210
Mailing Address - Country:US
Mailing Address - Phone:856-237-5533
Mailing Address - Fax:
Practice Address - Street 1:108 CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:EVESHAM
Practice Address - State:NJ
Practice Address - Zip Code:08053-4132
Practice Address - Country:US
Practice Address - Phone:732-833-3723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01015500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist