Healthcare Provider Details

I. General information

NPI: 1023306875
Provider Name (Legal Business Name): MONA TALEB MD/PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 S MAIN ST
FARMVILLE VA
23901-2211
US

IV. Provider business mailing address

222 HARRISON RD
CHESHIRE CT
06410-3569
US

V. Phone/Fax

Practice location:
  • Phone: 434-315-5340
  • Fax:
Mailing address:
  • Phone: 786-553-7047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number277288
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number55228
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101275053
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: