Healthcare Provider Details

I. General information

NPI: 1851337794
Provider Name (Legal Business Name): CYNTHIA C SU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1788 REPUBLIC RD STE 200
VIRGINIA BEACH VA
23454-4552
US

IV. Provider business mailing address

1788 REPUBLIC RD STE 200
VIRGINIA BEACH VA
23454-4552
US

V. Phone/Fax

Practice location:
  • Phone: 757-422-2966
  • Fax: 757-422-4563
Mailing address:
  • Phone: 757-422-2966
  • Fax: 757-422-4563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number0101840416
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: