Active NPI
Kelly Simeon
- Driver
- Deerfield Beach, FL
National Provider Identifier
1508482456
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- License
- S550500732920
- Practice address
- 360 SE 12TH Ave Apt 1
Deerfield Beach, FL 33441-4449 - Phone
- (954) 256-3673
- Fax
- (800) 390-1648
- NPI assigned
- Jun 17, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | S550500732920 | FL | Primary |
Addresses
Primary practice location
360 SE 12TH Ave Apt 1
Deerfield Beach, FL 33441-4449
Mailing address
PO Box 5941
Hollywood, FL 33083-5941
Phone (954) 256-3673
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S550500732920 | FL | MD | Driver |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1592352000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592352000000",
"number": "1508482456",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5941",
"city": "HOLLYWOOD",
"state": "FL",
"postal_code": "330835941",
"telephone_number": "954-256-3673",
"fax_number": "800-390-1648"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "360 SE 12TH AVE APT 1",
"city": "DEERFIELD BEACH",
"state": "FL",
"postal_code": "334414449",
"telephone_number": "954-256-3673",
"fax_number": "800-390-1648"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMEON",
"first_name": "KELLY",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-06-17",
"last_updated": "2020-06-17",
"certification_date": "2020-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "FL",
"license": "S550500732920",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Deerfield Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.