Provider Demographics
NPI:1336195593
Name:ELLIOTT, CYNTHIA LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LEE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13577 FEATHER SOUND DRIVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762
Mailing Address - Country:US
Mailing Address - Phone:727-571-1923
Mailing Address - Fax:727-572-5401
Practice Address - Street 1:13577 FEATHER SOUND DRIVE
Practice Address - Street 2:SUITE 350
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762
Practice Address - Country:US
Practice Address - Phone:727-571-1923
Practice Address - Fax:727-572-5401
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58121207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064401300Medicaid
FL11424OtherBCBS OF FLORIDA
FL064401300Medicaid
E59550Medicare UPIN