Healthcare Provider Details

I. General information

NPI: 1780108787
Provider Name (Legal Business Name): MEGHAN ASHLEY SIMON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E NASA BLVD STE 200
MELBOURNE FL
32901-1954
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-361-5621
  • Fax: 321-723-9176
Mailing address:
  • Phone: 321-723-9175
  • Fax: 321-723-9176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberPA9109755
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9109755
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: