Provider Demographics
NPI:1225766983
Name:MINCY, MYDELL
Entity Type:Individual
Prefix:
First Name:MYDELL
Middle Name:
Last Name:MINCY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43697-0346
Mailing Address - Country:US
Mailing Address - Phone:567-455-5334
Mailing Address - Fax:
Practice Address - Street 1:532 MAXWELL AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2408
Practice Address - Country:US
Practice Address - Phone:513-559-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator