=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124025382
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA LOUISE SILLS M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21638D TOMBALL PKWY
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77070-1646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-376-5921
-----------------------------------------------------
Fax | 281-251-4662
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14314 DECKER DR
-----------------------------------------------------
City | MAGNOLIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77355-8473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-356-1356
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | JO868
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------