Mia Rose Simoncelli, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F342490-1 Issued in NY

Practice address

PO Box T
Brocton, NY 14716-0679

Phone

(716) 792-7100

NPI assigned

Feb 9, 2018

Last updated

May 13, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mia Rose Hernandez Former name

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• General Physician, PC

  • General Practice Physician
  • Dunkirk, NY
  • NPI 1093959322
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1518134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715558400000",
    "number": "1689173171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX T",
            "city": "BROCTON",
            "state": "NY",
            "postal_code": "147160679",
            "telephone_number": "716-792-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX T",
            "city": "BROCTON",
            "state": "NY",
            "postal_code": "147160679",
            "telephone_number": "716-792-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMONCELLI",
        "first_name": "MIA",
        "middle_name": "ROSE",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-09",
        "last_updated": "2024-05-13",
        "certification_date": "2024-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F342490-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIA",
            "last_name": "HERNANDEZ",
            "middle_name": "ROSE",
            "credential": "FNP-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Laura Mackenzie Livengood, COTA
• Claudia Anne Monroe, P.T.
• Laura Lynn Neratko, LCSW
• Surendra Pattathan, DDS
• Laura Shelters, LPN
• Lawrence J Wilcox, NP

• Family Nurse Practitioner in Brocton, NY
• Providers in Brocton, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.