Provider Demographics
NPI:1952564015
Name:CIRILLO, MELISSA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:LYNN
Last Name:CIRILLO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-1390
Mailing Address - Fax:704-384-1063
Practice Address - Street 1:24 S WEBER ST STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1928
Practice Address - Country:US
Practice Address - Phone:866-226-8576
Practice Address - Fax:719-387-8974
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2014-017522084N0402X
CODR.00674782084N0402X
IL1250506952084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1952564015Medicaid
SCNC2254Medicaid
NCNCK891AMedicare PIN