MEDICARE: NYLA SIMMONS

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	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst		NY

General Provider Information

NPI Number	:	1316563687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NYLA SIMMONS

Provider Business Mailing Address
First Line	:	2959 AVENUE Y
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-1624
Country	:	US
Telephone Number	:	855-203-0631
Fax Number	:

Provider Business Practice Location Address
First Line	:	2959 AVENUE Y
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-1624
Country	:	US
Telephone Number	:	855-203-0631
Fax Number	:

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

Provider Enumeration Date	:	06/22/2020
Last Update Date	:	03/19/2026

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Directions to “ NYLA SIMMONS ” Practice Location

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