MEDICARE: CYNTHIA L THEISS MD PA

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	2084P0804X	Child & Adolescent Psychiatry Physician
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1962760751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYNTHIA L THEISS MD PA

Provider Business Mailing Address
First Line	:	5606 PGA BLVD STE 113
Second Line	:
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 STE 113
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-4122
Country	:	US
Telephone Number	:	561-296-3211
Fax Number	:	516-296-3212

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CYNTHIA L. THEISS
Credential	:	M.D.
Telephone Number	:	561-296-3211

Provider Enumeration Date	:	04/30/2012
Last Update Date	:	01/05/2017

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