Provider Demographics
NPI:1295289296
Name:YSEUX, MONIQUE
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:YSEUX
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 1:18230 STATE ROAD 19
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-9697
Mailing Address - Country:US
Mailing Address - Phone:407-520-8722
Mailing Address - Fax:877-399-5578
Practice Address - Street 1:18230 STATE ROAD 19 STE B201
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:FL
Practice Address - Zip Code:34736-9697
Practice Address - Country:US
Practice Address - Phone:407-520-8722
Practice Address - Fax:877-378-7597
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency