Provider Demographics
NPI:1831908243
Name:WALLACE, MONIQUE ASHA-KAYE
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:ASHA-KAYE
Last Name:WALLACE
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 1:7601 N FEDERAL HWY STE 225A
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1650
Mailing Address - Country:US
Mailing Address - Phone:305-833-0578
Mailing Address - Fax:
Practice Address - Street 1:7601 N FEDERAL HWY STE 225A
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1650
Practice Address - Country:US
Practice Address - Phone:772-448-7541
Practice Address - Fax:772-464-4048
Is Sole Proprietor?:No
Enumeration Date:2025-01-01
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide