Provider Demographics
NPI:1104346675
Name:BEAUDRY SIMONEAU, EVE (MD PHD)
Entity type:Individual
Prefix:MRS
First Name:EVE
Middle Name:
Last Name:BEAUDRY SIMONEAU
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:EVE
Other - Middle Name:
Other - Last Name:SIMONEAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PHD
Mailing Address - Street 1:622 WEST 168TH STREET
Mailing Address - Street 2:PH14-105
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:212-305-7369
Mailing Address - Fax:212-305-9139
Practice Address - Street 1:622 WEST 168TH STREET
Practice Address - Street 2:PH14-105
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-7369
Practice Address - Fax:212-305-9139
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2018-11-01
Deactivation Date:2018-02-01
Deactivation Code:
Reactivation Date:2018-07-10
Provider Licenses
StateLicense IDTaxonomies
NY295181204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery