Healthcare Provider Details

I. General information

NPI: 1003707464
Provider Name (Legal Business Name): ANDREW SIMONELLI RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5880 SAWMILL RD STE 150
DUBLIN OH
43017-7598
US

IV. Provider business mailing address

2 EASTON OVAL STE 115
COLUMBUS OH
43219-6042
US

V. Phone/Fax

Practice location:
  • Phone: 614-515-2500
  • Fax:
Mailing address:
  • Phone: 888-702-8343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.522472
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0043099
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: