Healthcare Provider Details

I. General information

NPI: 1821765983
Provider Name (Legal Business Name): CYNTHIA PODESTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 12/26/2022
Certification Date: 12/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 BROADWAY
TAUNTON MA
02780-3120
US

IV. Provider business mailing address

79 RANDALL ST APT 2
PAWTUCKET RI
02860-3770
US

V. Phone/Fax

Practice location:
  • Phone: 877-557-3155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2298283
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberRN2298283
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2298283
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: