Healthcare Provider Details

I. General information

NPI: 1659265874
Provider Name (Legal Business Name): MONICA PEVIDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BENMORE DR STE 201
WINTER PARK FL
32792-4111
US

IV. Provider business mailing address

133 BENMORE DR STE 201
WINTER PARK FL
32792-4111
US

V. Phone/Fax

Practice location:
  • Phone: 407-646-7070
  • Fax:
Mailing address:
  • Phone: 407-646-7469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number42764
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: