Provider Demographics
NPI:1285477752
Name:SCOTT SIMMONS, SHADAWN
Entity type:Individual
Prefix:
First Name:SHADAWN
Middle Name:
Last Name:SCOTT SIMMONS
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 1:5010 CATALPHA RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-2120
Mailing Address - Country:US
Mailing Address - Phone:443-627-0481
Mailing Address - Fax:
Practice Address - Street 1:5010 CATALPHA RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-2120
Practice Address - Country:US
Practice Address - Phone:443-627-0481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR197239163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse