Healthcare Provider Details

I. General information

NPI: 1225737091
Provider Name (Legal Business Name): BETHONY L CUYLER RA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 SUN N LAKE BLVD
SEBRING FL
33872-1986
US

IV. Provider business mailing address

112 LAKE OTIS RD
WINTER HAVEN FL
33884-1060
US

V. Phone/Fax

Practice location:
  • Phone: 863-949-9986
  • Fax:
Mailing address:
  • Phone: 863-513-5832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License NumberRA138
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: