Provider Demographics
NPI:1215462403
Name:KELLEY, CYNDA (LM)
Entity type:Individual
Prefix:
First Name:CYNDA
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2638 SE NORMAND ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-5052
Mailing Address - Country:US
Mailing Address - Phone:772-777-5972
Mailing Address - Fax:
Practice Address - Street 1:2638 SE NORMAND ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-5052
Practice Address - Country:US
Practice Address - Phone:772-777-5972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW346176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife