Healthcare Provider Details

I. General information

NPI: 1043283625
Provider Name (Legal Business Name): STACEY MARIE MONACO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST
ORLANDO FL
32803-1248
US

IV. Provider business mailing address

2501 N ORANGE AVE STE 446
ORLANDO FL
32804-4644
US

V. Phone/Fax

Practice location:
  • Phone: 407-975-0412
  • Fax:
Mailing address:
  • Phone: 407-975-0412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2006011991
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME158011
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2155-320
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: