Provider Demographics
NPI:1447098363
Name:SIMAS, JENNIFER NICOLE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NICOLE
Last Name:SIMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 COVEL AVE # 523
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12151-7727
Mailing Address - Country:US
Mailing Address - Phone:775-771-9829
Mailing Address - Fax:
Practice Address - Street 1:LASALLE SCHOOL
Practice Address - Street 2:391 WESTERN AVENUE
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-1401
Practice Address - Country:US
Practice Address - Phone:518-242-4731
Practice Address - Fax:518-242-4747
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY406173363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health