Healthcare Provider Details

I. General information

NPI: 1427292978
Provider Name (Legal Business Name): CINDY LEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 EDMUND PELLEGRINO RD
STONY BROOK NY
11794-0006
US

IV. Provider business mailing address

3 EDMUND PELLEGRINO RD CAROL BALDWIN BREAST CENTER
STONY BROOK NY
11794-1008
US

V. Phone/Fax

Practice location:
  • Phone: 631-638-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23879
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0070670
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD18023
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA124421
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number286719
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: