Provider Demographics
NPI:1861577918
Name:MONTES, STELLA BANAG (MD)
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:BANAG
Last Name:MONTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14225 LUDGATE HILL LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7921
Mailing Address - Country:US
Mailing Address - Phone:407-275-8577
Mailing Address - Fax:
Practice Address - Street 1:2316 HILLCREST ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4900
Practice Address - Country:US
Practice Address - Phone:407-894-6980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME741692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269590100Medicaid
FL42983UOtherMEDICARE PTAN NO.