Provider Demographics
NPI:1801065149
Name:WITKOWSKI, CYNTHIA L (MPH RD CDE LDN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:WITKOWSKI
Suffix:
Gender:F
Credentials:MPH RD CDE LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7143 STATE ROAD 54 UNIT 121
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-6104
Mailing Address - Country:US
Mailing Address - Phone:727-376-9757
Mailing Address - Fax:727-245-8670
Practice Address - Street 1:34921 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1969
Practice Address - Country:US
Practice Address - Phone:727-376-9757
Practice Address - Fax:727-245-8670
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5272133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBP829WMedicare PIN