Provider Demographics
NPI:1134202369
Name:MILES, CYNTHIA (MS,RD,CDE,CDN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:MS,RD,CDE,CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5945 161ST ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1414
Mailing Address - Country:US
Mailing Address - Phone:718-762-3111
Mailing Address - Fax:718-353-6315
Practice Address - Street 1:5945 161ST ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11365-1414
Practice Address - Country:US
Practice Address - Phone:718-762-3111
Practice Address - Fax:718-353-6315
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY92152MMedicare ID - Type Unspecified