Provider Demographics
NPI:1598738726
Name:EPPOLITO, CYNTHIA G (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:G
Last Name:EPPOLITO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:G
Other - Last Name:EPPOLITO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:2222 ROSEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-2206
Mailing Address - Country:US
Mailing Address - Phone:512-465-4840
Mailing Address - Fax:512-465-4841
Practice Address - Street 1:2222 ROSEWOOD AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-2206
Practice Address - Country:US
Practice Address - Phone:512-465-4840
Practice Address - Fax:512-465-4841
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04185363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB154935OtherWELLMED MEDICAL GROUP PA
Q35537Medicare UPIN
TXB154935OtherWELLMED MEDICAL GROUP PA