Provider Demographics
NPI:1649216763
Name:MONSALUD-WALLACE, MARY-JOY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY-JOY
Middle Name:
Last Name:MONSALUD-WALLACE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3327 MEDICAL HILL RD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-5531
Mailing Address - Country:US
Mailing Address - Phone:866-863-9122
Mailing Address - Fax:
Practice Address - Street 1:3327 MEDICAL HILL RD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5531
Practice Address - Country:US
Practice Address - Phone:866-863-9122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME137398207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0063312Medicaid
NJI23357Medicare UPIN
NJ086984B68Medicare ID - Type Unspecified