Healthcare Provider Details

I. General information

NPI: 1225615958
Provider Name (Legal Business Name): CYNTHIA CHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2021
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 WAYNE AVE
BRONX NY
10467-2509
US

IV. Provider business mailing address

3411 WAYNE AVE FL 2
BRONX NY
10467-2535
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-2680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: