Provider Demographics
NPI:1215777032
Name:SIMON, AN'TONAE SHANICE
Entity type:Individual
Prefix:
First Name:AN'TONAE
Middle Name:SHANICE
Last Name:SIMON
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 1:2895 SPRING FALL DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449
Mailing Address - Country:US
Mailing Address - Phone:513-567-4965
Mailing Address - Fax:
Practice Address - Street 1:2895 SPRING FALL DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45449
Practice Address - Country:US
Practice Address - Phone:513-567-4965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty