Provider Demographics
NPI:1861263139
Name:DUQUE, MILENA R
Entity type:Individual
Prefix:
First Name:MILENA
Middle Name:R
Last Name:DUQUE
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 1:1703 N MCMULLEN BOOTH RD UNIT 1440
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-9653
Mailing Address - Country:US
Mailing Address - Phone:727-485-4660
Mailing Address - Fax:
Practice Address - Street 1:13528 WOODSIDE DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6984
Practice Address - Country:US
Practice Address - Phone:502-889-9718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist