Provider Demographics
NPI:1609992890
Name:VELLIA, CINDY
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:VELLIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-2739
Mailing Address - Country:US
Mailing Address - Phone:937-878-1636
Mailing Address - Fax:
Practice Address - Street 1:314 RED OAK DR
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-2739
Practice Address - Country:US
Practice Address - Phone:937-878-1636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2255232Medicaid