Healthcare Provider Details

I. General information

NPI: 1720058886
Provider Name (Legal Business Name): CYNTHIA D MCDUFFEE MA,CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 TOLLAND TPKE 1E
MANCHESTER CT
06042-1771
US

IV. Provider business mailing address

360 TOLLAND TPKE 1E
MANCHESTER CT
06042-1771
US

V. Phone/Fax

Practice location:
  • Phone: 860-645-6675
  • Fax:
Mailing address:
  • Phone: 860-645-6675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number000196
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: