Provider Demographics
NPI:1780929182
Name:WILLIAMS, CYNTHIA
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14017 158TH ST
Mailing Address - Street 2:(APT B)
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-4321
Mailing Address - Country:US
Mailing Address - Phone:347-650-8710
Mailing Address - Fax:
Practice Address - Street 1:14017 158TH ST
Practice Address - Street 2:(APT B)
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-4321
Practice Address - Country:US
Practice Address - Phone:347-650-8710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY650073174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist