Provider Demographics
NPI:1710187976
Name:STURDIVANT, CYNTHIA CASLEY (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:CASLEY
Last Name:STURDIVANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:CASLEY
Other - Last Name:BREED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1271 STONEBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-9178
Mailing Address - Country:US
Mailing Address - Phone:209-366-4175
Mailing Address - Fax:
Practice Address - Street 1:4601 DALE RD
Practice Address - Street 2:ANESTHESIA OFFICE 2ND FLOOR
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9718
Practice Address - Country:US
Practice Address - Phone:209-366-4175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100017174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist