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General NPI Number Information
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NPI Number | 1013162510
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Entity Type | Individual
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Provider Name | CINDY A CALLAHAN RPA-C
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Gender | Female
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Dates
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Enumeration Date | 11/25/2008
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Last Update Date | 02/07/2011
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Provider Practice Location Address
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Address Line | 276 SMITHTOWN BLVD SUITE 1
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City | NESCONSET
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State | NY
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Zip | 11767-2084
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Country | US
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Telephone | 631-981-9143
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Fax |
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Provider Business Mailing Address
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Address Line | 39 LUBBER ST
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City | STONY BROOK
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State | NY
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Zip | 11790-1105
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Country | US
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Telephone | 631-793-6782
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 23 013023
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License Number State | NY
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