Provider Demographics
NPI:1619101656
Name:BLANCO, CY (MD)
Entity type:Individual
Prefix:DR
First Name:CY
Middle Name:
Last Name:BLANCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4675 LINTON BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6615
Mailing Address - Country:US
Mailing Address - Phone:561-331-5050
Mailing Address - Fax:
Practice Address - Street 1:4675 LINTON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6615
Practice Address - Country:US
Practice Address - Phone:561-331-5050
Practice Address - Fax:561-331-3711
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2023-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246212207L00000X, 2081P2900X
FLME146895207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03247303Medicaid
NYA400032530Medicare Oscar/Certification