Healthcare Provider Details

I. General information

NPI: 1023659554
Provider Name (Legal Business Name): CHIARINA SIMEONE HEYDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 N ROAD ST STE 9
ELIZABETH CITY NC
27909-3467
US

IV. Provider business mailing address

706 SMALL DR
ELIZABETH CITY NC
27909-7499
US

V. Phone/Fax

Practice location:
  • Phone: 252-331-1100
  • Fax:
Mailing address:
  • Phone: 252-202-4766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-09526
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: