MEDICARE: ELENA SIMONOVA

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	171100000X	Acupuncturist	3692	FL

General Provider Information

NPI Number	:	1558729400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA SIMONOVA

Provider Business Mailing Address
First Line	:	2814 GRANDE PKWY APT 106
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-2918
Country	:	US
Telephone Number	:	561-537-0399
Fax Number	:

Provider Business Practice Location Address
First Line	:	2814 GRANDE PKWY APT 106
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-2918
Country	:	US
Telephone Number	:	561-537-0399
Fax Number	:

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

Provider Enumeration Date	:	02/07/2016
Last Update Date	:	02/07/2016

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Directions to “ ELENA SIMONOVA ” Practice Location

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