Provider Demographics
NPI:1790398972
Name:BELLAMY, CEDRIA LACORYA (TRANSPORTATION)
Entity type:Individual
Prefix:MS
First Name:CEDRIA
Middle Name:LACORYA
Last Name:BELLAMY
Suffix:
Gender:F
Credentials:TRANSPORTATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8031 DREHER PARK LN APT 202
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-8717
Mailing Address - Country:US
Mailing Address - Phone:813-841-6640
Mailing Address - Fax:
Practice Address - Street 1:8031 DREHER PARK LN APT 202
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-8717
Practice Address - Country:US
Practice Address - Phone:813-841-6640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL999999Medicaid