Provider Demographics
NPI:1467603837
Name:STEWART, CYNTHIA LYNNE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LYNNE
Last Name:STEWART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:DR
Other - First Name:CYNTHIA
Other - Middle Name:LYNNE
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1020 LAKE SUMTER LNDG
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-2699
Mailing Address - Country:US
Mailing Address - Phone:352-674-8905
Mailing Address - Fax:352-674-8919
Practice Address - Street 1:8877 SE 165TH MULBERRY LN
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5887
Practice Address - Country:US
Practice Address - Phone:352-674-1750
Practice Address - Fax:352-674-8950
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03994103TC0700X
MDC0003861363AM0700X
FLPA9107330363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHU858ZMedicare PIN