Healthcare Provider Details

I. General information

NPI: 1124052899
Provider Name (Legal Business Name): CYNTHIA MARIE SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5424 DISCOVERY PARK BLVD SUITE 201
WILLIAMSBURG VA
23188-2904
US

IV. Provider business mailing address

860 OMNI BLVD SUITE 303
NEWPORT NEWS VA
23606-4430
US

V. Phone/Fax

Practice location:
  • Phone: 757-345-6330
  • Fax: 757-345-6896
Mailing address:
  • Phone: 757-232-8777
  • Fax: 757-232-8866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number22010010088
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: