Healthcare Provider Details

I. General information

NPI: 1790594976
Provider Name (Legal Business Name): CYNDI MARIE SEVITTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 02/16/2025
Certification Date: 02/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409-2711
US

IV. Provider business mailing address

857 HUMMINGBIRD CT
TIPP CITY OH
45371-1400
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-8000
  • Fax:
Mailing address:
  • Phone: 937-403-6477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number362598
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAPRN.CNP.0038712
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: