=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003743899
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHARDEAH S SIMMONS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2026
-----------------------------------------------------
Last Update Date | 05/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7301A W PALMETTO PARK RD STE 100C
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33433-3403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-248-1171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 233 CYPRESS TRCE
-----------------------------------------------------
City | ROYAL PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33411-4799
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-949-1004
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | RBT-25-415433
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------