Healthcare Provider Details

I. General information

NPI: 1326435850
Provider Name (Legal Business Name): CYNTHIS SANDLIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9382 W OVERLAND RD
BOISE ID
83709-2505
US

IV. Provider business mailing address

9382 W OVERLAND RD
BOISE ID
83709-2505
US

V. Phone/Fax

Practice location:
  • Phone: 208-375-1221
  • Fax:
Mailing address:
  • Phone: 208-375-1221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberM-4612
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: