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General NPI Number Information
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NPI Number | 1558868885
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Entity Type | Individual
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Provider Name | JACQUELINE SIMEON
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Gender | Female
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Dates
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Enumeration Date | 04/12/2018
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Last Update Date | 04/12/2018
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Provider Practice Location Address
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Address Line | 8785 SW 165TH AVE STE 106D
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City | MIAMI
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State | FL
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Zip | 33193-5827
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Country | US
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Telephone | 786-391-2935
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Fax | 786-409-2019
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Provider Business Mailing Address
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Address Line | 770 NW 35TH CT
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City | MIAMI
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State | FL
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Zip | 33125-3811
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Country | US
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Telephone | 786-246-3457
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Fax | 786-409-2019
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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 | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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