MEDICARE: DR. CYNTHIA L. THEISS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME 0072048	FL

General Provider Information

NPI Number	:	1598821845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA L. THEISS M.D.

Provider Business Mailing Address
First Line	:	5606 PGA BLVD
Second Line	:	SUITE 113
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-4122
Country	:	US
Telephone Number	:	561-296-3211
Fax Number	:	561-296-3212

Provider Business Practice Location Address
First Line	:	5606 PGA BLVD
Second Line	:	SUITE 113
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-4122
Country	:	US
Telephone Number	:	561-296-3211
Fax Number	:	561-296-3212

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	07/09/2007

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