MEDICARE: MISS HAVEN SIMON-CAMPBELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	0019019523	VA

General Provider Information

NPI Number	:	1447122213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS HAVEN SIMON-CAMPBELL

Provider Business Mailing Address
First Line	:	1190 LYNNHAVEN PKWY
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-4814
Country	:	US
Telephone Number	:	757-468-5444
Fax Number	:	757-468-2091

Provider Business Practice Location Address
First Line	:	1190 LYNNHAVEN PKWY
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-4814
Country	:	US
Telephone Number	:	757-468-5444
Fax Number	:	757-468-2091

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2025
Last Update Date	:	09/22/2025

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Directions to “ MISS HAVEN SIMON-CAMPBELL ” Practice Location

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