Healthcare Provider Details

I. General information

NPI: 1700472404
Provider Name (Legal Business Name): CYNTHIA DENISE ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3831 W VINE ST STE 60
KISSIMMEE FL
34741-4650
US

IV. Provider business mailing address

3043 BLOOMSBURY DR
KISSIMMEE FL
34747-1616
US

V. Phone/Fax

Practice location:
  • Phone: 407-559-4854
  • Fax:
Mailing address:
  • Phone: 407-338-0484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: