Healthcare Provider Details

I. General information

NPI: 1861313983
Provider Name (Legal Business Name): SHOSHANA SIMAS MA#75174
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 RACETRACK RD NW
FORT WALTON BEACH FL
32547-1642
US

IV. Provider business mailing address

945 ASHLEY LN UNIT E
FORT WALTON BEACH FL
32547-6765
US

V. Phone/Fax

Practice location:
  • Phone: 850-240-5353
  • Fax:
Mailing address:
  • Phone: 850-699-1326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA75174
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: