MEDICARE: MONIQUE DANIELLE MOODY CPT, CMA,DSP

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	372600000X	Adult Companion	2025B09366	AZ
2	3747A0650X	Attendant Care Provider	2025B09366	AZ
3	3747P1801X	Personal Care Attendant	2025B09366	AZ
4	374U00000X	Home Health Aide	2025B09366	AZ
5	246RP1900X	Phlebotomy Technician	INST3437836425	MI

General Provider Information

NPI Number	:	1720936651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE DANIELLE MOODY CPT, CMA,DSP

Provider Business Mailing Address
First Line	:	7780 N 57TH LN
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85301-7872
Country	:	US
Telephone Number	:	480-407-9396
Fax Number	:

Provider Business Practice Location Address
First Line	:	7780 N 57TH LN
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85301-7872
Country	:	US
Telephone Number	:	480-407-9396
Fax Number	:

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

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	06/01/2026

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Directions to “ MONIQUE DANIELLE MOODY CPT, CMA,DSP” Practice Location

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