Provider Demographics
NPI:1578062972
Name:MONCADO, LINDY DIANNE
Entity Type:Individual
Prefix:
First Name:LINDY
Middle Name:DIANNE
Last Name:MONCADO
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 1:258 PATHWAY RD
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-8772
Mailing Address - Country:US
Mailing Address - Phone:417-699-9459
Mailing Address - Fax:
Practice Address - Street 1:258 PATHWAY RD
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-8772
Practice Address - Country:US
Practice Address - Phone:417-699-9459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO$$$$$$$$$Medicaid