Provider Demographics
NPI:1700866514
Name:BRIONES, CYLLENE C (MD)
Entity Type:Individual
Prefix:
First Name:CYLLENE
Middle Name:C
Last Name:BRIONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1763
Mailing Address - Country:US
Mailing Address - Phone:484-337-4286
Mailing Address - Fax:484-337-4293
Practice Address - Street 1:5800 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1746
Practice Address - Country:US
Practice Address - Phone:570-366-4606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4383082084P0800X, 2084P0800X
IN010619342084P0800X
IN01061934A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64095680Medicaid
IN200160000Medicare PIN
KY00668911Medicare ID - Type UnspecifiedOMHS MEDICARE #
KY64095680Medicaid