Sending a SIM Command from an Azure Virtual Machine with Node.js involves setting up an Ubuntu Virtual Machine using the Azure CLI and sending a Twilio SIM Command using Node.js. The process requires installing Azure CLI, Node.js, npm, and Twilio library, as well as creating a new resource group, virtual machine, and SSH keys. A Bash script is then used to automate the installation of dependencies and generate a .js file called sendcommand.js, which sends a new Command to a Twilio SIM using the Commands API.