Healthcare Provider Details

I. General information

NPI: 1083080055
Provider Name (Legal Business Name): CYNTHIA PEW BC-HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17700 MURDOCK CIR
PORT CHARLOTTE FL
33948-1054
US

IV. Provider business mailing address

17700 MURDOCK CIR
PORT CHARLOTTE FL
33948-1054
US

V. Phone/Fax

Practice location:
  • Phone: 941-249-6014
  • Fax:
Mailing address:
  • Phone: 941-249-6014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS5450
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: