Healthcare Provider Details

I. General information

NPI: 1295057354
Provider Name (Legal Business Name): SHARONELLE SIMMONS, M.D
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 S MCCLINTOCK DR STE 104
TEMPE AZ
85283-3268
US

IV. Provider business mailing address

6200 S MCCLINTOCK DR STE 104
TEMPE AZ
85283-3268
US

V. Phone/Fax

Practice location:
  • Phone: 480-388-3666
  • Fax: 480-388-3667
Mailing address:
  • Phone: 480-388-3666
  • Fax: 480-388-3667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13628
License Number StateAZ

VIII. Authorized Official

Name: DR. SHARONELLE SIMMONS
Title or Position: MEMBER/MEDICAL DIRECTOR
Credential: M.D.
Phone: 480-949-1182