Provider Demographics
NPI:1134307077
Name:BLACK, CYNTHIA R (AP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:R
Last Name:BLACK
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6339 KONDLA PL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-8202
Mailing Address - Country:US
Mailing Address - Phone:941-323-3493
Mailing Address - Fax:941-925-8891
Practice Address - Street 1:6339 KONDLA PL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-8202
Practice Address - Country:US
Practice Address - Phone:941-323-3493
Practice Address - Fax:941-925-8891
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2513171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist