Healthcare Provider Details

I. General information

NPI: 1720936651
Provider Name (Legal Business Name): MONIQUE DANIELLE MOODY CPT, CMA,DSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7780 N 57TH LN
GLENDALE AZ
85301-7872
US

IV. Provider business mailing address

7780 N 57TH LN
GLENDALE AZ
85301-7872
US

V. Phone/Fax

Practice location:
  • Phone: 480-407-9396
  • Fax:
Mailing address:
  • Phone: 480-407-9396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number2025B09366
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number2025B09366
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number2025B09366
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number2025B09366
License Number StateAZ
# 5
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberINST3437836425
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: