Provider Demographics
NPI:1477058303
Name:MONIR, REESA LENDRY (MD)
Entity type:Individual
Prefix:
First Name:REESA
Middle Name:LENDRY
Last Name:MONIR
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 LUCERNE TER
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2007
Mailing Address - Country:US
Mailing Address - Phone:321-841-6903
Mailing Address - Fax:
Practice Address - Street 1:1502 LUCERNE TER
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2007
Practice Address - Country:US
Practice Address - Phone:321-841-6903
Practice Address - Fax:321-841-6913
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME158010207NP0225X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114927600Medicaid