Provider Demographics
NPI:1114638970
Name:SEREY, CINDY MAE
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:MAE
Last Name:SEREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 TEAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-4322
Mailing Address - Country:US
Mailing Address - Phone:713-504-8124
Mailing Address - Fax:
Practice Address - Street 1:3804 TEAKWOOD DR
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-4322
Practice Address - Country:US
Practice Address - Phone:713-504-8124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH15766884Medicaid