Provider Demographics
NPI:1659566305
Name:MCDONALD, CYNTHIA LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LYNN
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:LYNN
Other - Last Name:HOLLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:6 ISLIP STREET
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742
Mailing Address - Country:US
Mailing Address - Phone:631-513-0808
Mailing Address - Fax:631-289-2979
Practice Address - Street 1:38 HARTS RD
Practice Address - Street 2:
Practice Address - City:EAST MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11940
Practice Address - Country:US
Practice Address - Phone:631-878-8917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2404351164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02044948Medicaid