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General NPI Number Information
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NPI Number | 1831775469
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Entity Type | Individual
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Provider Name | KHALED MOUMNEH DO, MSC
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Gender | Male
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Dates
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Enumeration Date | 03/23/2021
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 1592 S SR 15A
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City | DELAND
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State | FL
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Zip | 32720-7786
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Country | US
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Telephone | 386-734-2931
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Fax | 386-734-2939
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Provider Business Mailing Address
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Address Line | 9 CYPRESS BLVD E
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City | HOMOSASSA
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State | FL
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Zip | 34446-4714
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Country | US
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Telephone | 207-400-4418
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | OS19194
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License Number State | FL
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