Healthcare Provider Details

I. General information

NPI: 1841238268
Provider Name (Legal Business Name): CYNTHIA L LYDIARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 SUFFIELD ST
AGAWAM MA
01001-1752
US

IV. Provider business mailing address

62 SUFFIELD ST
AGAWAM MA
01001-1752
US

V. Phone/Fax

Practice location:
  • Phone: 413-786-3383
  • Fax: 413-786-2388
Mailing address:
  • Phone: 413-786-3383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MS. CYNTHIA LEE LYDIARD
Title or Position: PROPRIETOR
Credential: CERTIFIED FITTER
Phone: 413-786-3383