MEDICARE: SORINA SIMEON

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	MA83056	FL

General Provider Information

NPI Number	:	1609324052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SORINA SIMEON

Provider Business Mailing Address
First Line	:	421 NE 168TH TER
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-3961
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	421 NE 168TH TER
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-3961
Country	:	US
Telephone Number	:	305-741-1674
Fax Number	:

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

Provider Enumeration Date	:	09/14/2016
Last Update Date	:	09/14/2016

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Directions to “ SORINA SIMEON ” Practice Location

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