Healthcare Provider Details

I. General information

NPI: 1992642433
Provider Name (Legal Business Name): AMY MONSOUR RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 SW 104TH CT
MIAMI FL
33165-3718
US

IV. Provider business mailing address

3540 SW 104TH CT
MIAMI FL
33165-3718
US

V. Phone/Fax

Practice location:
  • Phone: 786-632-5522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number9244
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: