Provider Demographics
NPI:1093798837
Name:NOVOTNY, CYNTHIA D (PA-C)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:D
Last Name:NOVOTNY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:440-293-2444
Mailing Address - Fax:440-293-2445
Practice Address - Street 1:5594 STATE ROUTE 7
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:OH
Practice Address - Zip Code:44003-9490
Practice Address - Country:US
Practice Address - Phone:440-293-2444
Practice Address - Fax:440-293-2445
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA000897363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS61157Medicare UPIN
PA014250RN0Medicare PIN