Healthcare Provider Details

I. General information

NPI: 1942275318
Provider Name (Legal Business Name): CYNTHIA R. PASCHAL-PULLIAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 GARDEN WAY
HERMITAGE PA
16148-5209
US

IV. Provider business mailing address

699 E STATE ST
SHARON PA
16146-2057
US

V. Phone/Fax

Practice location:
  • Phone: 724-983-5454
  • Fax: 724-983-5419
Mailing address:
  • Phone: 724-983-3820
  • Fax: 724-983-3941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP007983
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: