Provider Demographics
NPI:1023765781
Name:STANFORD, CINDY
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:STANFORD
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 1:345 INDIAN VALLEY RD NW
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-6806
Mailing Address - Country:US
Mailing Address - Phone:540-449-4001
Mailing Address - Fax:
Practice Address - Street 1:345 INDIAN VALLEY RD NW
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-6806
Practice Address - Country:US
Practice Address - Phone:540-449-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001191012163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management