Provider Demographics
NPI:1154374049
Name:NIENDORFF, CYNTHIA M (MD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:NIENDORFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 DUNHILL PL NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3885
Mailing Address - Country:US
Mailing Address - Phone:423-339-9581
Mailing Address - Fax:423-472-0454
Practice Address - Street 1:102 DUNHILL PL NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311
Practice Address - Country:US
Practice Address - Phone:423-339-9581
Practice Address - Fax:423-472-0454
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4942207L00000X
TN49391207LP2900X, 207L00000X
TNMD0000049391208VP0014X, 2081P2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1530651Medicaid
I06965Medicare UPIN
TN1530651Medicaid
TN1530651Medicaid