MEDICARE: MS. SHERAN MAXWELL SIMO NP

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	363LF0000X	Family Nurse Practitioner	71000703A	IN
2	363LF0000X	Family Nurse Practitioner	004573	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497740062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHERAN MAXWELL SIMO NP

Provider Business Mailing Address
First Line	:	226 MILL HILL AVE
Second Line	:	3RD FLOOR
City	:	BRIDGEPORT
State	:	CT
Zip	:	06610-2826
Country	:	US
Telephone Number	:	203-384-3042
Fax Number	:

Provider Business Practice Location Address
First Line	:	267 GRANT ST
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06610-2805
Country	:	US
Telephone Number	:	203-384-3042
Fax Number	:

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	06/19/2015

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