Provider Demographics
NPI:1457102527
Name:RICHARDSON, CYNTHIA (LPN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:NEWTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:650 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2319
Mailing Address - Country:US
Mailing Address - Phone:315-426-7741
Mailing Address - Fax:315-426-5455
Practice Address - Street 1:650 MADISON ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2319
Practice Address - Country:US
Practice Address - Phone:315-426-7741
Practice Address - Fax:315-426-5455
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285202164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse