Healthcare Provider Details

I. General information

NPI: 1760943609
Provider Name (Legal Business Name): MONICA J SACCUCCI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 08/28/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 DIXMYTH AVE # 6
CINCINNATI OH
45220-2475
US

IV. Provider business mailing address

379 DIXMYTH AVE # 6
CINCINNATI OH
45220-2475
US

V. Phone/Fax

Practice location:
  • Phone: 513-246-7027
  • Fax: 513-246-7560
Mailing address:
  • Phone: 513-246-7027
  • Fax: 513-246-7560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35.150097
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number35.150097
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: