Provider Demographics
NPI:1205836533
Name:KALLET, CYNTHIA ECLAVEA (DO)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ECLAVEA
Last Name:KALLET
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3328 S SMITHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1500
Mailing Address - Country:US
Mailing Address - Phone:937-254-5661
Mailing Address - Fax:937-254-7367
Practice Address - Street 1:3328 S SMITHVILLE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420-1500
Practice Address - Country:US
Practice Address - Phone:937-254-5661
Practice Address - Fax:937-254-7367
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine