Healthcare Provider Details

I. General information

NPI: 1962760751
Provider Name (Legal Business Name): CYNTHIA L THEISS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5606 PGA BLVD STE 113
PALM BEACH GARDENS FL
33418-4122
US

IV. Provider business mailing address

5606 PGA BLVD STE 113
PALM BEACH GARDENS FL
33418-4122
US

V. Phone/Fax

Practice location:
  • Phone: 561-296-3211
  • Fax: 516-296-3212
Mailing address:
  • Phone: 561-296-3211
  • Fax: 561-296-3212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CYNTHIA L. THEISS
Title or Position: OWNER
Credential: M.D.
Phone: 561-296-3211