Provider Demographics
NPI:1184621062
Name:CANTWELL, CYNTHIA M (FNP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:CANTWELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TITUS PLACE
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NY
Mailing Address - Zip Code:13856
Mailing Address - Country:US
Mailing Address - Phone:607-865-2400
Mailing Address - Fax:607-865-7305
Practice Address - Street 1:2 TITUS PLACE
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:NY
Practice Address - Zip Code:13856
Practice Address - Country:US
Practice Address - Phone:607-865-2400
Practice Address - Fax:607-865-7305
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333391363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10024786OtherCDPHP
NY160025193OtherTRAVELERS RR MEDICARE
NYS50551Medicare UPIN
NYBB2554Medicare ID - Type Unspecified