Provider Demographics
NPI:1952411498
Name:MENDES, CELIA M (MD)
Entity Type:Individual
Prefix:MRS
First Name:CELIA
Middle Name:M
Last Name:MENDES
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 1:1357 WALTER REED RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4415
Mailing Address - Country:US
Mailing Address - Phone:910-486-6400
Mailing Address - Fax:
Practice Address - Street 1:1357 WALTER REED RD
Practice Address - Street 2:SUITE 201
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4415
Practice Address - Country:US
Practice Address - Phone:910-486-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501337174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891267EMedicaid
NC891267EMedicaid
NC2216454BMedicare PIN