Healthcare Provider Details

I. General information

NPI: 1285540732
Provider Name (Legal Business Name): JUDITH SIMBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5519 MODLY CT
ADAMSTOWN MD
21710-1409
US

IV. Provider business mailing address

5519 MODLY CT
ADAMSTOWN MD
21710-1409
US

V. Phone/Fax

Practice location:
  • Phone: 954-519-8988
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR257338
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: