Healthcare Provider Details

I. General information

NPI: 1447276852
Provider Name (Legal Business Name): MONALI MANIKAL M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 08/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WHETSTONE PL SUITES 205
ST AUGUSTINE FL
32086-5774
US

IV. Provider business mailing address

1093 A1A BEACH BLVD PMB 415
ST AUGUSTINE FL
32080-6733
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-9925
  • Fax: 904-819-9926
Mailing address:
  • Phone: 904-819-9925
  • Fax: 904-819-9926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 81118
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: