Provider Demographics
NPI:1194755645
Name:MOSS-MELLMAN, CHERYL M (MD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:M
Last Name:MOSS-MELLMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1001 NW 13TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2269
Mailing Address - Country:US
Mailing Address - Phone:561-955-6663
Mailing Address - Fax:561-955-2879
Practice Address - Street 1:690 MEADOWS RD FL 2
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2344
Practice Address - Country:US
Practice Address - Phone:561-955-2131
Practice Address - Fax:561-955-3758
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057953207R00000X
FLME57953207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E66631Medicare UPIN
FL11488Medicare ID - Type Unspecified