Provider Demographics
NPI:1568295327
Name:SIMMONDS, SHATIMA
Entity type:Individual
Prefix:
First Name:SHATIMA
Middle Name:
Last Name:SIMMONDS
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 1:1211 STATE ROAD 436 STE 171
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-6442
Mailing Address - Country:US
Mailing Address - Phone:407-894-1708
Mailing Address - Fax:
Practice Address - Street 1:1211 STATE ROAD 436 STE 171
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-6442
Practice Address - Country:US
Practice Address - Phone:407-894-1708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health