Healthcare Provider Details

I. General information

NPI: 1649524612
Provider Name (Legal Business Name): CINDY L CALLISTO MSN/FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 ZUNI RD SE STE 11
ALBUQUERQUE NM
87108-2935
US

IV. Provider business mailing address

PO BOX 740018
ATLANTA GA
30374-0018
US

V. Phone/Fax

Practice location:
  • Phone: 505-777-3002
  • Fax:
Mailing address:
  • Phone: 505-777-3002
  • Fax: 505-521-5189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number63085
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number235304
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: