Healthcare Provider Details

I. General information

NPI: 1265438824
Provider Name (Legal Business Name): CYNTHIA LEE SIMPSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 FULLER ST
ALEXANDRIA BAY NY
13607
US

IV. Provider business mailing address

4 FULLER ST
ALEXANDRIA BAY NY
13607
US

V. Phone/Fax

Practice location:
  • Phone: 315-482-2511
  • Fax: 315-482-4981
Mailing address:
  • Phone: 315-482-2511
  • Fax: 315-482-4981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF3317951
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5410175
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: