Provider Demographics
NPI:1407004823
Name:SURGUINE, MONICA CLARE (ATC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:CLARE
Last Name:SURGUINE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 GREYSTONE LN
Mailing Address - Street 2:APT 2A
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-5997
Mailing Address - Country:US
Mailing Address - Phone:928-210-6212
Mailing Address - Fax:
Practice Address - Street 1:100 VALLEY CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808
Practice Address - Country:US
Practice Address - Phone:302-994-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer