Provider Demographics
NPI:1568753580
Name:MILLER, CYNTHIA S (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:S
Last Name:MILLER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8880 CANDLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CLARENCE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14032-9717
Mailing Address - Country:US
Mailing Address - Phone:716-989-9656
Mailing Address - Fax:
Practice Address - Street 1:17 LIMESTONE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8600
Practice Address - Country:US
Practice Address - Phone:716-458-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF403008-01363LP0808X
NY403008363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health