Healthcare Provider Details

I. General information

NPI: 1871803759
Provider Name (Legal Business Name): SUN'DA MARIE SIMMONS STNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6809 MAYFIELD RD APT 1150
MAYFIELD HTS OH
44124-2267
US

IV. Provider business mailing address

6809 MAYFIELD RD APT 1150
MAYFIELD HTS OH
44124-2267
US

V. Phone/Fax

Practice location:
  • Phone: 216-780-2770
  • Fax: 216-373-1409
Mailing address:
  • Phone: 216-780-2770
  • Fax: 216-373-1409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number375397980296
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2472R0900X
TaxonomyRenal Dialysis Technician
License Number209090
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number261026090011
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: