Provider Demographics
NPI:1184712499
Name:CHERNYAKHOVSKY, CYNTHIA (PAC)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:
Last Name:CHERNYAKHOVSKY
Suffix:
Gender:
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8022 MOSS MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3908
Mailing Address - Country:US
Mailing Address - Phone:214-553-9617
Mailing Address - Fax:
Practice Address - Street 1:700 WALTER REED BLVD
Practice Address - Street 2:SUITE 311
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-3701
Practice Address - Country:US
Practice Address - Phone:972-487-6400
Practice Address - Fax:972-487-1686
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01701363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA01701OtherSTATE LICENSE NUMBER
TXPA01701OtherSTATE LICENSE NUMBER
89093FMedicare ID - Type Unspecified