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General NPI Number Information
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NPI Number | 1538198346
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Entity Type | Individual
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Provider Name | MARY K. STAILEY-SIMS DO
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Gender | Female
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 05/24/2013
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Provider Practice Location Address
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Address Line | 435 HURFFVILLE CROSS KEYS RD
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City | TURNERSVILLE
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State | NJ
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Zip | 08012-2453
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Country | US
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Telephone | 856-582-2816
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Fax | 856-582-2712
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Provider Business Mailing Address
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Address Line | 402 LIPPINCOTT DR
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City | MARLTON
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State | NJ
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Zip | 08053-4112
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Country | US
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Telephone | 856-782-3300
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Fax | 856-504-8029
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MB74225
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License Number State | NJ
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