Provider Demographics
NPI:1982314498
Name:MODESTE, JANIS MONROSE (EDD, MED)
Entity type:Individual
Prefix:DR
First Name:JANIS
Middle Name:MONROSE
Last Name:MODESTE
Suffix:
Gender:
Credentials:EDD, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 WINDY MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-5607
Mailing Address - Country:US
Mailing Address - Phone:352-978-7424
Mailing Address - Fax:886-363-4026
Practice Address - Street 1:1725 E HWY 50 STE A
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5188
Practice Address - Country:US
Practice Address - Phone:352-978-7424
Practice Address - Fax:886-363-0930
Is Sole Proprietor?:No
Enumeration Date:2022-11-25
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
FL181282106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171400000XOther Service ProvidersHealth & Wellness Coach