Provider Demographics
NPI:1295819043
Name:GERARDI, CYNTHIA M
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:M
Last Name:GERARDI
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 1:4495 MILITARY TRL STE 204
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4818
Mailing Address - Country:US
Mailing Address - Phone:561-296-1122
Mailing Address - Fax:561-296-5566
Practice Address - Street 1:4495 MILITARY TRL STE 204
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4818
Practice Address - Country:US
Practice Address - Phone:561-296-1122
Practice Address - Fax:561-296-5566
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191193-0174400000X
FLME141617207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY168581Medicare PIN
NYG6352Medicare UPIN