Healthcare Provider Details

I. General information

NPI: 1477195493
Provider Name (Legal Business Name): TONY GERARD MOODY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9885 N US HIGHWAY 1 LOT 5B
SEBASTIAN FL
32958-6322
US

IV. Provider business mailing address

9885 N US HIGHWAY 1 LOT 5B
SEBASTIAN FL
32958-6322
US

V. Phone/Fax

Practice location:
  • Phone: 772-713-6194
  • Fax:
Mailing address:
  • Phone: 772-713-6194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: