Healthcare Provider Details

I. General information

NPI: 1689707283
Provider Name (Legal Business Name): SHYNI A SIMON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MEDICAL PKWY SUITE 200
ANNAPOLIS MD
21401-3742
US

IV. Provider business mailing address

PO BOX 64294
BALTIMORE MD
21264-4294
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-5300
  • Fax: 443-481-6705
Mailing address:
  • Phone: 443-481-6482
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR153217
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: