Healthcare Provider Details

I. General information

NPI: 1356905798
Provider Name (Legal Business Name): TIMOTHY REED MONACO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 SENECA MEADOWS RD
WINTER SPRINGS FL
32708-4725
US

IV. Provider business mailing address

723 SENECA MEADOWS RD
WINTER SPRINGS FL
32708-4725
US

V. Phone/Fax

Practice location:
  • Phone: 541-948-7018
  • Fax:
Mailing address:
  • Phone: 541-948-7018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number98588
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number4598
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: