Provider Demographics
NPI:1366806119
Name:CYR, ANDREA KELLEY (DO)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:KELLEY
Last Name:CYR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1260 CITY CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3810
Practice Address - Country:US
Practice Address - Phone:214-970-6817
Practice Address - Fax:317-218-8990
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02007031A2081S0010X, 208100000X
IL036.1535272081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1103771823OtherANTHEM PTAN
IN300074246Medicaid