Provider Demographics
NPI:1578750915
Name:DIEFENBECK, CYNTHIA A (CNS)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:DIEFENBECK
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:A
Other - Last Name:PEARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:910 S CHAPEL ST
Mailing Address - Street 2:# 102
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-3467
Mailing Address - Country:US
Mailing Address - Phone:302-224-1400
Mailing Address - Fax:302-224-1402
Practice Address - Street 1:910 S CHAPEL ST
Practice Address - Street 2:# 102
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-3467
Practice Address - Country:US
Practice Address - Phone:302-224-1400
Practice Address - Fax:302-224-1402
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELE-0000143364S00000X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DELE-0000143OtherDE MEDICAL LICENSE NUMBER
DELE-0000143OtherDE MEDICAL LICENSE NUMBER