Provider Demographics
NPI:1174604425
Name:SIMON, EDNEA A
Entity type:Individual
Prefix:
First Name:EDNEA
Middle Name:A
Last Name:SIMON
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 1:550 17TH AVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5788
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 17TH AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5788
Practice Address - Country:US
Practice Address - Phone:206-215-1440
Practice Address - Fax:206-215-1441
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044096208000000X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8441875Medicaid
246360OtherINTERNAL ID-MOTOR VEHICLE ID
246360OtherINTERNAL ID-MOTOR VEHICLE ID
I46953Medicare UPIN