Provider Demographics
NPI:1295172500
Name:DESEPEDA, CYNTHIA ENRIQUEZ (MD EARLY CHILDHOOD)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:ENRIQUEZ
Last Name:DESEPEDA
Suffix:
Gender:F
Credentials:MD EARLY CHILDHOOD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5764 MAZEAU ST
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1927
Mailing Address - Country:US
Mailing Address - Phone:347-224-5516
Mailing Address - Fax:
Practice Address - Street 1:9777 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3335
Practice Address - Country:US
Practice Address - Phone:718-830-9274
Practice Address - Fax:718-830-0761
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist