Provider Demographics
NPI:1811286339
Name:ADU, MONIQUE CHERYL (DO)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:CHERYL
Last Name:ADU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:CHERYL
Other - Last Name:CUNNINGHAM-LINDSAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:204 N WESTOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-2983
Mailing Address - Country:US
Mailing Address - Phone:229-405-6249
Mailing Address - Fax:229-329-4373
Practice Address - Street 1:1712C E BROAD AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31705-2611
Practice Address - Country:US
Practice Address - Phone:229-405-6249
Practice Address - Fax:229-329-4373
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13860208000000X
GA072282208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019050700Medicaid