Provider Demographics
NPI:1831775469
Name:MOUMNEH, KHALED (DO, MSC)
Entity type:Individual
Prefix:
First Name:KHALED
Middle Name:
Last Name:MOUMNEH
Suffix:
Gender:
Credentials:DO, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CYPRESS BLVD E
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-4714
Mailing Address - Country:US
Mailing Address - Phone:207-400-4418
Mailing Address - Fax:
Practice Address - Street 1:1592 S SR 15A
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-7786
Practice Address - Country:US
Practice Address - Phone:386-734-2931
Practice Address - Fax:386-734-2939
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
FLOS19194207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program