Provider Demographics
NPI:1366049991
Name:DIAZ, CYNTHIA ANNETTE (NP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANNETTE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 REMSEN RD APT 4H
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-1859
Mailing Address - Country:US
Mailing Address - Phone:917-531-3583
Mailing Address - Fax:
Practice Address - Street 1:506 FORT WASHINGTON AVE APT 1F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-2081
Practice Address - Country:US
Practice Address - Phone:212-568-0553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF345800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily