Provider Demographics
NPI:1871803759
Name:SIMMONS, SUN'DA MARIE (STNA)
Entity type:Individual
Prefix:MS
First Name:SUN'DA
Middle Name:MARIE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6809 MAYFIELD RD APT 1150
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2267
Mailing Address - Country:US
Mailing Address - Phone:216-780-2770
Mailing Address - Fax:216-373-1409
Practice Address - Street 1:6809 MAYFIELD RD APT 1150
Practice Address - Street 2:
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2267
Practice Address - Country:US
Practice Address - Phone:216-780-2770
Practice Address - Fax:216-373-1409
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261026090011246RP1900X
OH375397980296247200000X
OH2090902472R0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal Dialysis