Basic Information
Provider Information
NPI: 1114183282
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BAILEY-BROWN
FirstName: SIMONE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 100 KINGS HIGHWAY SOUTH
Address2: PROVIDER ENROLLMENT
City: ROCHESTER
State: NY
PostalCode: 146175504
CountryCode: US
TelephoneNumber: 5859221304
FaxNumber:  
Practice Location
Address1: 2365 S CLINTON AVE
Address2:  
City: ROCHESTER
State: NY
PostalCode: 14618
CountryCode: US
TelephoneNumber: 5854425320
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/29/2008
LastUpdateDate: 04/23/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/23/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000X294222NYY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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