Provider Demographics
NPI:1295211225
Name:VERDIEU, MONICA (DEVELOPMENTALTHERAPY)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:VERDIEU
Suffix:
Gender:F
Credentials:DEVELOPMENTALTHERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 BUCCANEER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-1960
Mailing Address - Country:US
Mailing Address - Phone:407-459-5704
Mailing Address - Fax:
Practice Address - Street 1:827 BUCCANEER BLVD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-1960
Practice Address - Country:US
Practice Address - Phone:407-459-5704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-12
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103964900Medicaid