Healthcare Provider Details

I. General information

NPI: 1407519432
Provider Name (Legal Business Name): CHELSEY SIMONI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2021
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 CEDAR RD
N ATTLEBORO MA
02763-1107
US

IV. Provider business mailing address

306 THAYER ST UNIT 2694
PROVIDENCE RI
02906-7716
US

V. Phone/Fax

Practice location:
  • Phone: 401-965-7097
  • Fax:
Mailing address:
  • Phone: 202-599-6477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN2331408
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberRN2331408
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberRN2331408
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberRN62862
License Number StateRI
# 5
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberRN2331408
License Number StateMA
# 6
Primary TaxonomyY
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License NumberRN2331408
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: