Provider Demographics
NPI:1780714683
Name:PERRINO, CYNTHIA L (RD)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:L
Last Name:PERRINO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 EWING RD
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-3212
Mailing Address - Country:US
Mailing Address - Phone:330-758-4725
Mailing Address - Fax:
Practice Address - Street 1:13207 RAVENNA RD
Practice Address - Street 2:UH GEAUGA MEDICAL CENTER
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-7032
Practice Address - Country:US
Practice Address - Phone:440-285-6157
Practice Address - Fax:440-286-6069
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.2393133V00000X
PALD002940133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered