Provider Demographics
NPI:1427064666
Name:HARRIS, CINDY JOY (DO)
Entity type:Individual
Prefix:DR
First Name:CINDY
Middle Name:JOY
Last Name:HARRIS
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 1:401 W INTERLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-0701
Mailing Address - Country:US
Mailing Address - Phone:863-465-1725
Mailing Address - Fax:863-465-2595
Practice Address - Street 1:401 W INTERLAKE BLVD
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-0701
Practice Address - Country:US
Practice Address - Phone:863-465-1725
Practice Address - Fax:863-465-2595
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2304207Q00000X
FLOS10805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1481AOtherBCBS
FL001823400Medicaid
FLP00879880OtherRRMC
FL001823400Medicaid