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General NPI Number Information
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NPI Number | 1982314498
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Entity Type | Individual
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Provider Name | JANIS MONROSE MODESTE ED.D, M.ED.
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Gender | Female
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Dates
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Enumeration Date | 11/25/2022
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 1725 E HWY 50 STE A
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City | CLERMONT
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State | FL
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Zip | 34711-5188
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Country | US
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Telephone | 352-978-7424
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Fax | 886-363-0930
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Provider Business Mailing Address
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Address Line | 1211 WINDY MEADOW DR
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City | MINNEOLA
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State | FL
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Zip | 34715-5607
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Country | US
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Telephone | 352-978-7424
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Fax | 886-363-4026
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 181282
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License Number State | FL
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