Healthcare Provider Details

I. General information

NPI: 1588010953
Provider Name (Legal Business Name): SIMONE M CHANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TAMPA GENERAL CIR
TAMPA FL
33606-3571
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-0001
US

V. Phone/Fax

Practice location:
  • Phone: 813-821-8038
  • Fax: 813-974-0483
Mailing address:
  • Phone: 813-821-8038
  • Fax: 813-974-0483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberT4722
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberT4722
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberME166105
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: