Provider Demographics
NPI:1376010595
Name:MONACELLI, MARIA ANN
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ANN
Last Name:MONACELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 N GOODMAN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1186
Mailing Address - Country:US
Mailing Address - Phone:585-325-3145
Mailing Address - Fax:
Practice Address - Street 1:320 N GOODMAN ST STE 202
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1186
Practice Address - Country:US
Practice Address - Phone:585-325-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist