Provider Demographics
NPI:1780686212
Name:CYR, MELISSA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CYR
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 1:350 HANSEN PLZ
Mailing Address - Street 2:SUITE 311
Mailing Address - City:LYNDORA
Mailing Address - State:PA
Mailing Address - Zip Code:16045-1610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 HANSEN PLZ
Practice Address - Street 2:SUITE 311
Practice Address - City:LYNDORA
Practice Address - State:PA
Practice Address - Zip Code:16045-1610
Practice Address - Country:US
Practice Address - Phone:724-283-6184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010099L207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001955414Medicaid
PA068413SDBMedicare PIN
PA001955414Medicaid