Provider Demographics
NPI:1467071761
Name:GRANT, CYNTHIA
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:GRANT
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 1:47 HYDE ST
Mailing Address - Street 2:
Mailing Address - City:WHITNEY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:13862-2821
Mailing Address - Country:US
Mailing Address - Phone:607-644-8299
Mailing Address - Fax:
Practice Address - Street 1:47 HYDE ST
Practice Address - Street 2:
Practice Address - City:WHITNEY POINT
Practice Address - State:NY
Practice Address - Zip Code:13862-2821
Practice Address - Country:US
Practice Address - Phone:607-644-8299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health