Healthcare Provider Details

I. General information

NPI: 1124943097
Provider Name (Legal Business Name): LEGACY RHEUMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 W INDIANTOWN RD STE A201
JUPITER FL
33458-6839
US

IV. Provider business mailing address

1015 W INDIANTOWN RD STE A201
JUPITER FL
33458-6839
US

V. Phone/Fax

Practice location:
  • Phone: 561-747-1987
  • Fax: 561-747-1313
Mailing address:
  • Phone: 561-747-1987
  • Fax: 561-747-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: EKATERINA SIMAKOVA
Title or Position: PHYSICIAN
Credential: MD
Phone: 561-747-1987