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General NPI Number Information
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NPI Number | 1104193945
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Entity Type | Individual
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Provider Name | BROOKE LYNETTE MANOCCHIO D.O.
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Gender | Female
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Dates
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Enumeration Date | 11/22/2011
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 6661 CLYO RD
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City | CENTERVILLE
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State | OH
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Zip | 45459-2702
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Country | US
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Telephone | 937-425-4000
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Fax | 937-425-4002
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Provider Business Mailing Address
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Address Line | 1 PRESTIGE PL SUITE 550
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City | MIAMISBURG
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State | OH
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Zip | 45342-3794
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Country | US
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Telephone | 937-762-1305
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Fax | 937-522-7513
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 58.004216
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34011470
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License Number State | OH
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