Provider Demographics
NPI:1669451795
Name:MOHNEY, CYNTHIA S (PAC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:S
Last Name:MOHNEY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 RENZULLI RD
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-1726
Mailing Address - Country:US
Mailing Address - Phone:386-663-3061
Mailing Address - Fax:386-663-3066
Practice Address - Street 1:1860 RENZULLI RD
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-1726
Practice Address - Country:US
Practice Address - Phone:386-663-3061
Practice Address - Fax:386-663-3066
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC50000298363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2264WMedicare PIN
S76250Medicare UPIN