Provider Demographics
NPI:1760781843
Name:TETTEH, CYNTHIA (LPN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:TETTEH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 BOYNTON AVE
Mailing Address - Street 2:APT-17C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-4750
Mailing Address - Country:US
Mailing Address - Phone:718-671-2100
Mailing Address - Fax:
Practice Address - Street 1:875 BOYNTON AVE
Practice Address - Street 2:APT-17C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-4750
Practice Address - Country:US
Practice Address - Phone:718-671-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304905164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse