Provider Demographics
NPI:1063469955
Name:PENN, CECILIA NAA-SAKLE (MD, MPH, FAAP)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:NAA-SAKLE
Last Name:PENN
Suffix:
Gender:F
Credentials:MD, MPH, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 RED HOOK PLZ
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-1305
Mailing Address - Country:US
Mailing Address - Phone:340-513-2888
Mailing Address - Fax:
Practice Address - Street 1:6501 RED HOOK PLZ
Practice Address - Street 2:SUITE 201
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-1305
Practice Address - Country:US
Practice Address - Phone:340-513-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1425208000000X
MDD62776208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407470000Medicaid
MDKR51JHMedicare ID - Type UnspecifiedGROUP
MDI41514Medicare UPIN
MDM433Medicare ID - Type UnspecifiedINDIVIDUAL