Provider Demographics
NPI:1184103723
Name:PONDY, MONIQUE CLARYSSE (MD)
Entity type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:CLARYSSE
Last Name:PONDY
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 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3513
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:515 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MENTONE
Practice Address - State:IN
Practice Address - Zip Code:46539-9723
Practice Address - Country:US
Practice Address - Phone:574-353-7561
Practice Address - Fax:260-479-2908
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN01086633A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program