Provider Demographics
NPI:1457775900
Name:SAMMON, CYNTHIA LEE (RN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LEE
Last Name:SAMMON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-3007
Mailing Address - Country:US
Mailing Address - Phone:845-608-4942
Mailing Address - Fax:
Practice Address - Street 1:601 W 26TH ST
Practice Address - Street 2:SUITE 522
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-1101
Practice Address - Country:US
Practice Address - Phone:212-268-5999
Practice Address - Fax:212-268-7667
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4427721163W00000X
NJ26NO09719700163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse