Provider Demographics
NPI:1881979482
Name:DIMITRI, CYNTHIA R (MSCCC,SLP)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:R
Last Name:DIMITRI
Suffix:
Gender:F
Credentials:MSCCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 GARDEN PKWY
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6632
Mailing Address - Country:US
Mailing Address - Phone:716-634-4975
Mailing Address - Fax:
Practice Address - Street 1:282 GARDEN PKWY
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6632
Practice Address - Country:US
Practice Address - Phone:716-634-4975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7605--1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist