Provider Demographics
NPI:1558501148
Name:FOSU, CYNTHIA
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:FOSU
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 1:1704 GRAND AVE
Mailing Address - Street 2:APT 3-E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-7761
Mailing Address - Country:US
Mailing Address - Phone:917-519-7033
Mailing Address - Fax:
Practice Address - Street 1:1704 GRAND AVE
Practice Address - Street 2:APT 3-E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-7761
Practice Address - Country:US
Practice Address - Phone:917-519-7033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295474164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse