Healthcare Provider Details

I. General information

NPI: 1871781146
Provider Name (Legal Business Name): CYNTHIA D HENSLEY MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26661 DUBLIN WOODS CIR
BONITA SPRINGS FL
34135-7224
US

IV. Provider business mailing address

26661 DUBLIN WOODS CIR
BONITA SPRINGS FL
34135-7224
US

V. Phone/Fax

Practice location:
  • Phone: 239-390-9933
  • Fax: 239-390-2095
Mailing address:
  • Phone: 239-390-9933
  • Fax: 239-390-2095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberME79598
License Number StateFL

VIII. Authorized Official

Name: DR. CYNTHIA D HENSLEY
Title or Position: CEO
Credential: M.D.
Phone: 239-390-9933