MEDICARE: SHARON RENEE SIMON DNP, FNP-C, PMHNP-C

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024173276	VA
2	363LF0000X	Family Nurse Practitioner	0024173276	VA

General Provider Information

NPI Number	:	1487013504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON RENEE SIMON DNP, FNP-C, PMHNP-C

Provider Business Mailing Address
First Line	:	11350 MCCORMICK RD
Second Line	:
City	:	HUNT VALLEY
State	:	MD
Zip	:	21031-1002
Country	:	US
Telephone Number	:	410-329-1071
Fax Number	:	410-329-1054

Provider Business Practice Location Address
First Line	:	1420 SPRING HILL RD STE 210
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-3039
Country	:	US
Telephone Number	:	703-738-4342
Fax Number	:	703-642-1876

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

Provider Enumeration Date	:	02/17/2016
Last Update Date	:	05/26/2026

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