Provider Demographics
NPI:1821050980
Name:PORCELLI, MONICA TUNDE (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:TUNDE
Last Name:PORCELLI
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 1:6020 SEASIDE DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-2019
Mailing Address - Country:US
Mailing Address - Phone:813-785-4249
Mailing Address - Fax:727-868-0312
Practice Address - Street 1:12136 COBBLESTONE DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-2432
Practice Address - Country:US
Practice Address - Phone:727-863-5474
Practice Address - Fax:727-868-0312
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83393208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262800700Medicaid