Provider Demographics
NPI:1851930440
Name:ANDERSON, CYNITRA TINIKA
Entity Type:Individual
Prefix:MS
First Name:CYNITRA
Middle Name:TINIKA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CYNITRA
Other - Middle Name:TINIKA
Other - Last Name:MOSES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:623 DORCHESTER DR APT 126
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4028
Mailing Address - Country:US
Mailing Address - Phone:248-565-7370
Mailing Address - Fax:248-817-8878
Practice Address - Street 1:623 DORCHESTER DR APT 126
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4028
Practice Address - Country:US
Practice Address - Phone:248-565-7370
Practice Address - Fax:248-817-8878
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI800315464OtherCHAMPS