Provider Demographics
NPI:1790495109
Name:BODDY, CYDNIE ANN
Entity Type:Individual
Prefix:
First Name:CYDNIE
Middle Name:ANN
Last Name:BODDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-2004
Mailing Address - Country:US
Mailing Address - Phone:304-539-2547
Mailing Address - Fax:
Practice Address - Street 1:1520 LEWIS ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-2004
Practice Address - Country:US
Practice Address - Phone:304-539-2547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant