Healthcare Provider Details

I. General information

NPI: 1962472761
Provider Name (Legal Business Name): CYNTHIA SABIN EADES M.S., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR 60 MDG/SGPQ
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

101 BODIN CIR 60 MDG/SGPQ
TRAVIS AFB CA
94535-1809
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-7163
  • Fax:
Mailing address:
  • Phone: 707-423-7163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201000435
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: