Healthcare Provider Details

I. General information

NPI: 1124930672
Provider Name (Legal Business Name): CYNTHIA BENNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 CLOVER ST
WINDSOR CT
06095-3709
US

IV. Provider business mailing address

126 CLOVER ST
WINDSOR CT
06095-3709
US

V. Phone/Fax

Practice location:
  • Phone: 860-534-1123
  • Fax:
Mailing address:
  • Phone: 860-534-1123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number80002
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: