Healthcare Provider Details

I. General information

NPI: 1003743899
Provider Name (Legal Business Name): SHARDEAH S SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301A W PALMETTO PARK RD STE 100C
BOCA RATON FL
33433-3403
US

IV. Provider business mailing address

233 CYPRESS TRCE
ROYAL PALM BEACH FL
33411-4799
US

V. Phone/Fax

Practice location:
  • Phone: 954-248-1171
  • Fax:
Mailing address:
  • Phone: 407-949-1004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberRBT-25-415433
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: