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General NPI Number Information
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NPI Number | 1699972521
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Entity Type | Individual
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Provider Name | SHANDY M. MONBORNE LMT
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Gender | Female
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 237 N. GROVE ST
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City | MERRITT ISLAND
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State | FL
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Zip | 32953
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Country | US
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Telephone | 321-452-1226
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Fax |
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Provider Business Mailing Address
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Address Line | 1620 LARCHMONT COURT
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City | MERRITT ISLAND
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State | FL
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Zip | 32952
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Country | US
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Telephone | 321-480-8771
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Fax |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MM 17487
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License Number State | FL
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