Healthcare Provider Details

I. General information

NPI: 1366707895
Provider Name (Legal Business Name): CYNTHIA G CONNOLLY HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 MAIN ST
ORLEANS MA
02653-9998
US

IV. Provider business mailing address

PO BOX 1690
ORLEANS MA
02653
US

V. Phone/Fax

Practice location:
  • Phone: 508-225-4421
  • Fax:
Mailing address:
  • Phone: 508-255-4421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number258
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: