Healthcare Provider Details

I. General information

NPI: 1205805991
Provider Name (Legal Business Name): MONIQUE P DIBBS VALLEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONIQUE P DIBBS VALLEE MD

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9981 S HEALTHPARK DR
FORT MYERS FL
33908-3618
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-6260
  • Fax: 239-343-6259
Mailing address:
  • Phone: 239-343-6260
  • Fax: 239-343-6259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14736R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME82202
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberME82202
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: