Provider Demographics
NPI:1780675843
Name:MELLOY, CINDA JENSEN (MD)
Entity Type:Individual
Prefix:
First Name:CINDA
Middle Name:JENSEN
Last Name:MELLOY
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 1:1900 CENTRACARE CIR
Mailing Address - Street 2:CENTRACARE CLINIC
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-654-3630
Mailing Address - Fax:320-654-3657
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:CENTRACARE CLINIC
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-654-3630
Practice Address - Fax:320-654-3657
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32044208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
110409OtherU CARE
51A33JEOtherBLUE CROSS BLUE SHIELD
HP25485OtherHEALTH PARTNERS
254011OtherPREFERRED ONE
763855OtherARAZ GROUP
1202202OtherMEDICA HEALTH PLANS
659588000OtherMEDICAL ASSISTANCE
2114179OtherFIRST HEALTH PLAN
659588000OtherMEDICAL ASSISTANCE
763855OtherARAZ GROUP