Provider Demographics
NPI:1518963487
Name:SIETO, CYNTHIA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MARIE
Last Name:SIETO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2895 HAMILTON BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-6172
Mailing Address - Country:US
Mailing Address - Phone:610-435-8986
Mailing Address - Fax:610-435-8307
Practice Address - Street 1:2895 HAMILTON BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-6172
Practice Address - Country:US
Practice Address - Phone:610-435-8986
Practice Address - Fax:610-435-8307
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051355363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA051355OtherPHYSICIAN ASST. LICENSE #
PAMA051355OtherPHYSICIAN ASST. LICENSE #