Healthcare Provider Details
I. General information
NPI: 1053935767
Provider Name (Legal Business Name): MONET DANIELLE WINSLOW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 05/29/2020
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
6535 NEMOURS PKWY
ORLANDO FL
32827-7884
US
IV. Provider business mailing address
10140 CENTURION PKWY N
JACKSONVILLE FL
32256-0532
US
V. Phone/Fax
- Phone: 407-650-7000
- Fax:
- Phone: 904-697-4100
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 390200000X |
| Taxonomy | Student in an Organized Health Care Education/Training Program |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | ME163145 |
| License Number State | FL |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: