Healthcare Provider Details

I. General information

NPI: 1104725522
Provider Name (Legal Business Name): SIMON MUROKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2026
Last Update Date: 11/03/2026
Certification Date: 11/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 DUDLEY RD
SUTTON MA
01590-3034
US

IV. Provider business mailing address

99 DUDLEY RD
SUTTON MA
01590-3034
US

V. Phone/Fax

Practice location:
  • Phone: 508-615-9910
  • Fax:
Mailing address:
  • Phone: 508-615-9910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN2267536
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: