Provider Demographics
NPI:1851603443
Name:FUSILLO, CINDY (LPN)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:FUSILLO
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 1:21 IDLEWILD AVE
Mailing Address - Street 2:APT 5
Mailing Address - City:CORNWALL ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12520-1138
Mailing Address - Country:US
Mailing Address - Phone:845-741-1239
Mailing Address - Fax:
Practice Address - Street 1:21 IDLEWILD AVE
Practice Address - Street 2:APT 5
Practice Address - City:CORNWALL ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12520-1138
Practice Address - Country:US
Practice Address - Phone:845-741-1239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292157-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse