Healthcare Provider Details

I. General information

NPI: 1255235354
Provider Name (Legal Business Name): CYNTHIA MCFADDEN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22438 REGENCY DR APT 2A
RICHTON PARK IL
60471-2155
US

IV. Provider business mailing address

22438 REGENCY DR APT 2A
RICHTON PARK IL
60471-2155
US

V. Phone/Fax

Practice location:
  • Phone: 224-489-7402
  • Fax:
Mailing address:
  • Phone: 224-489-7402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number041507300
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: