Provider Demographics
NPI:1396823605
Name:MUNYAN, CYNTHIA SUE (RD LD CDE)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:SUE
Last Name:MUNYAN
Suffix:
Gender:F
Credentials:RD LD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7908 DOLMEN DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-8539
Mailing Address - Country:US
Mailing Address - Phone:614-577-0761
Mailing Address - Fax:614-566-8453
Practice Address - Street 1:111 S GRANT AVE
Practice Address - Street 2:NUTRITION SERVICES
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4701
Practice Address - Country:US
Practice Address - Phone:614-566-9183
Practice Address - Fax:614-566-8453
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1094133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH81001Medicare ID - Type UnspecifiedMEDICARE