Provider Demographics
NPI:1245375351
Name:WAKED, MONDA T (DC)
Entity type:Individual
Prefix:
First Name:MONDA
Middle Name:T
Last Name:WAKED
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7257 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4907
Mailing Address - Country:US
Mailing Address - Phone:440-205-9910
Mailing Address - Fax:440-974-2400
Practice Address - Street 1:7249 CENTER ST STE 2
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4907
Practice Address - Country:US
Practice Address - Phone:440-205-9910
Practice Address - Fax:440-974-2400
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor