Provider Demographics
NPI:1801055835
Name:EDWARDS, CYNTHIA (OTR)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 BAYCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2313
Mailing Address - Country:US
Mailing Address - Phone:718-655-1362
Mailing Address - Fax:718-515-3868
Practice Address - Street 1:4041 BAYCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2313
Practice Address - Country:US
Practice Address - Phone:718-655-1362
Practice Address - Fax:718-515-3868
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006190-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist