Healthcare Provider Details

I. General information

NPI: 1588584494
Provider Name (Legal Business Name): SIMONE ISABELLA HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 BERGEN AVE
BRONX NY
10455-4010
US

IV. Provider business mailing address

600 W 139TH ST APT 8
NEW YORK NY
10031-7338
US

V. Phone/Fax

Practice location:
  • Phone: 718-542-8084
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: