Provider Demographics
NPI:1851096622
Name:MARCELUS, CINDY
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:MARCELUS
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 1:1608 W SHERWIN AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-7940
Mailing Address - Country:US
Mailing Address - Phone:954-534-1033
Mailing Address - Fax:
Practice Address - Street 1:1608 W SHERWIN AVE APT 304
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-7940
Practice Address - Country:US
Practice Address - Phone:954-534-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant