MEDICARE: DR. MICHELLE COLLEEN MONK PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY10064	FL
2	103TC0700X	Clinical Psychologist	071005156	IL

General Provider Information

NPI Number	:	1700168325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE COLLEEN MONK PH.D.

Provider Business Mailing Address
First Line	:	3662 AVALON PARK EAST BLVD STE 2022
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-7760
Country	:	US
Telephone Number	:	312-246-0814
Fax Number	:

Provider Business Practice Location Address
First Line	:	3662 AVALON PARK EAST BLVD STE 2022
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-7760
Country	:	US
Telephone Number	:	312-246-0814
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2011
Last Update Date	:	04/24/2023

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