MEDICARE: MISS SIMONE ASHBY

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	247200000X	Other Technician		FL

General Provider Information

NPI Number	:	1194255547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SIMONE ASHBY

Provider Business Mailing Address
First Line	:	4575 SE DIXIE HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-6826
Country	:	US
Telephone Number	:	786-973-7377
Fax Number	:

Provider Business Practice Location Address
First Line	:	419 W 49TH ST STE 210
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3657
Country	:	US
Telephone Number	:	305-822-9063
Fax Number	:

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

Provider Enumeration Date	:	06/18/2017
Last Update Date	:	06/18/2017

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Directions to “ MISS SIMONE ASHBY ” Practice Location

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