Provider Demographics
NPI:1679799050
Name:ANDERSON, CYNTHIA LOUISE (ND)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LOUISE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 MOREHOUSE ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-3232
Mailing Address - Country:US
Mailing Address - Phone:203-556-6163
Mailing Address - Fax:
Practice Address - Street 1:3519 POST RD
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:CT
Practice Address - Zip Code:06890-1180
Practice Address - Country:US
Practice Address - Phone:203-254-2633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000340175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath