Healthcare Provider Details

I. General information

NPI: 1093017824
Provider Name (Legal Business Name): CYNTHIA JEAN STEWART R.N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2010
Last Update Date: 11/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 KIRK RD
ROCHESTER NY
14612-3377
US

IV. Provider business mailing address

45 WILLOWOOD DR
ROCHESTER NY
14612-3209
US

V. Phone/Fax

Practice location:
  • Phone: 585-966-4316
  • Fax: 585-966-4339
Mailing address:
  • Phone: 585-966-4305
  • Fax: 585-966-4387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number438152-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: