Provider Demographics
NPI:1851709430
Name:BRAGALONE, CYNTHIA
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:BRAGALONE
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:PO BOX 63
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45343-0063
Mailing Address - Country:US
Mailing Address - Phone:937-247-5295
Mailing Address - Fax:937-247-5297
Practice Address - Street 1:1053 DUNAWAY ST
Practice Address - Street 2:APT. 2
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-8803
Practice Address - Country:US
Practice Address - Phone:937-247-5295
Practice Address - Fax:937-247-5297
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401092100510376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0058310Medicaid