Provider Demographics
NPI:1902322654
Name:AMELUNGE, MONICA JEAN (PSR)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:JEAN
Last Name:AMELUNGE
Suffix:
Gender:F
Credentials:PSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 MADELYN WAY APT 207
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3282
Mailing Address - Country:US
Mailing Address - Phone:407-448-0776
Mailing Address - Fax:
Practice Address - Street 1:1071 PORT MALABAR BLVD NE STE 106
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5161
Practice Address - Country:US
Practice Address - Phone:407-720-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)