Basic Information
| Provider Information | |||||||||
| NPI: | 1689707283 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMON | ||||||||
| FirstName: | SHYNI | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 64294 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212644294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434816482 | ||||||||
| FaxNumber: | 4434816515 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 MEDICAL PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214013742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434815300 | ||||||||
| FaxNumber: | 4434816705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 11/22/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R153217 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 91145401 | 01 | BCBS MD | OTHER | 91145403 | 01 | MD | BCBS | OTHER | 91145404 | 01 | MD | BCBS | OTHER | V8740004 | 01 | DC | BCBS | OTHER | 145724700 | 01 | MD | FEDERAL WORKMAN'S COMP | OTHER | 325633 | 01 | MD | AMERIGROUP | OTHER | 58860011 | 01 | BCBS DC | OTHER | V8380005 | 01 | DC | BCBS | OTHER | 911454-03 | 01 | BCBS MARYLAND | OTHER | 412648300 | 05 | MD | MEDICAID | 6301091 | 01 | AETNA HMO | OTHER | 9678143 | 01 | AETNA PPO | OTHER | V8080005 | 01 | DC | BCBS | OTHER |