Provider Demographics
NPI:1871292177
Name:MONKOSKI, AMANDA KAY (LDO)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:KAY
Last Name:MONKOSKI
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-8776
Mailing Address - Country:US
Mailing Address - Phone:904-431-9882
Mailing Address - Fax:
Practice Address - Street 1:549 HICKORY DR
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-8776
Practice Address - Country:US
Practice Address - Phone:904-431-9882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO6846156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician