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General NPI Number Information
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NPI Number | 1902322654
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Entity Type | Individual
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Provider Name | MONICA JEAN AMELUNGE PSR
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Gender | Female
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Dates
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Enumeration Date | 08/15/2017
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Last Update Date | 08/15/2017
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Provider Practice Location Address
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Address Line | 1071 PORT MALABAR BLVD NE STE 106
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City | PALM BAY
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State | FL
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Zip | 32905-5161
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Country | US
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Telephone | 407-720-8887
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Fax |
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Provider Business Mailing Address
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Address Line | 726 MADELYN WAY APT 207
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City | MELBOURNE
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State | FL
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Zip | 32901-3282
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Country | US
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Telephone | 407-448-0776
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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