Provider Demographics
NPI:1053561753
Name:MONCAYO, MICHELLE E (SLP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:E
Last Name:MONCAYO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 GLENRIO RD NW
Mailing Address - Street 2:JOHN ADAMS MS
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-1273
Mailing Address - Country:US
Mailing Address - Phone:505-831-0400
Mailing Address - Fax:
Practice Address - Street 1:5401 GLENRIO RD NW
Practice Address - Street 2:JOHN ADAMS MS
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-1273
Practice Address - Country:US
Practice Address - Phone:505-831-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC 4399235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNONE ASSIGNEDMedicaid