Healthcare Provider Details

I. General information

NPI: 1275364184
Provider Name (Legal Business Name): SHELBY SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7025 HARBOUR VIEW BLVD
SUFFOLK VA
23435-2761
US

IV. Provider business mailing address

1525 E PASS RD APT 328
GULFPORT MS
39507-3551
US

V. Phone/Fax

Practice location:
  • Phone: 757-974-8282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5263
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202012460
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: