MEDICARE: SYNOVIA J SIMONS RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	LD008045	GA
2	133V00000X	Registered Dietitian	DT92671	TX
3	133V00000X	Registered Dietitian		AZ
4	133V00000X	Registered Dietitian	164022535	IL
5	133V00000X	Registered Dietitian	ND9208	FL
6	133V00000X	Registered Dietitian		VA
7	133V00000X	Registered Dietitian		MI

General Provider Information

NPI Number	:	1174189534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYNOVIA J SIMONS RDN

Provider Business Mailing Address
First Line	:	PO BOX 1402
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33568-1402
Country	:	US
Telephone Number	:	813-847-9705
Fax Number	:

Provider Business Practice Location Address
First Line	:	10810 BOYETTE RD UNIT 1402
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33569-8000
Country	:	US
Telephone Number	:	252-267-6580
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2019
Last Update Date	:	03/25/2026

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