Provider Demographics
NPI:1831475631
Name:MCINTYRE, CYNTHIA R (MS)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:R
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12132 WEST MAIN STREET ROAD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NY
Mailing Address - Zip Code:14772
Mailing Address - Country:US
Mailing Address - Phone:716-763-1801
Mailing Address - Fax:
Practice Address - Street 1:2615 NORTH MAPLE AVENUE
Practice Address - Street 2:HEWES EDUCATIONAL CENTER
Practice Address - City:ASHVILLE
Practice Address - State:NY
Practice Address - Zip Code:14710
Practice Address - Country:US
Practice Address - Phone:716-763-1801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018350235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY018350OtherNEW YORK STATE LICENSE