Provider Demographics
NPI:1437110830
Name:PICKNEY, CYNTHIA (DO)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:
Last Name:PICKNEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10051 5TH ST. NORTH
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2211
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:727-568-6011
Practice Address - Street 1:10051 5TH ST. NORTH
Practice Address - Street 2:SUITE 200
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2211
Practice Address - Country:US
Practice Address - Phone:727-824-0780
Practice Address - Fax:727-568-6011
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39959207R00000X
FLOS12055207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30095600Medicaid
WI30095600Medicaid
H10896Medicare UPIN