MEDICARE: DR. JANIS MONROSE MODESTE ED.D, M.ED.

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	171400000X	Health & Wellness Coach
2	106S00000X	Behavior Technician	181282	FL

General Provider Information

NPI Number	:	1982314498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANIS MONROSE MODESTE ED.D, M.ED.

Provider Business Mailing Address
First Line	:	1211 WINDY MEADOW DR
Second Line	:
City	:	MINNEOLA
State	:	FL
Zip	:	34715-5607
Country	:	US
Telephone Number	:	352-978-7424
Fax Number	:	886-363-4026

Provider Business Practice Location Address
First Line	:	1725 E HWY 50 STE A
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-5188
Country	:	US
Telephone Number	:	352-978-7424
Fax Number	:	886-363-0930

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

Provider Enumeration Date	:	11/25/2022
Last Update Date	:	02/18/2025

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