Provider Demographics
NPI:1477533271
Name:STEWART-CYRUS, MELODY (MD)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:STEWART-CYRUS
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 1:401 HIGHLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3839
Mailing Address - Country:US
Mailing Address - Phone:859-626-7700
Mailing Address - Fax:
Practice Address - Street 1:401 HIGHLAND PARK DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3839
Practice Address - Country:US
Practice Address - Phone:859-626-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350930222080A0000X
KY579492080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2155304Medicaid
OH2155304Medicaid
WV000000228235OtherANTHEM
KY64003445Medicaid
WV001709560OtherMT. STATE
WV5630141000Medicaid
WV00058839OtherRR MEDICARE
WVH04443Medicare UPIN
OH2155304Medicaid