Healthcare Provider Details

I. General information

NPI: 1508412271
Provider Name (Legal Business Name): DYSHAUNA SIMMONS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2019
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 DAVIS AVE FL 6
NEPTUNE NJ
07753-4488
US

IV. Provider business mailing address

19 DAVIS AVE FL 6
NEPTUNE NJ
07753-4488
US

V. Phone/Fax

Practice location:
  • Phone: 732-897-2770
  • Fax: 732-897-3970
Mailing address:
  • Phone: 732-897-2770
  • Fax: 732-897-3970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number26NJ00945900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00945900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: