MEDICARE: DR. MICHAEL G SIMONDS PSY D

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	103G00000X	Clinical Neuropsychologist	PY7308	FL
2	103TC0700X	Clinical Psychologist	PY7308	FL

General Provider Information

NPI Number	:	1659355808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL G SIMONDS PSY D

Provider Business Mailing Address
First Line	:	1620 W OAKLAND PARK BLVD STE 403
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33311-1533
Country	:	US
Telephone Number	:	954-486-8899
Fax Number	:

Provider Business Practice Location Address
First Line	:	1620 W OAKLAND PARK BLVD STE 403
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33311-1533
Country	:	US
Telephone Number	:	954-486-8899
Fax Number	:	954-567-0022

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

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	11/15/2023

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