Provider Demographics
NPI:1194402164
Name:CYRUS, ATHENIA (MBA,CP)
Entity type:Individual
Prefix:
First Name:ATHENIA
Middle Name:
Last Name:CYRUS
Suffix:
Gender:F
Credentials:MBA,CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1371 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14208-1830
Mailing Address - Country:US
Mailing Address - Phone:510-575-7113
Mailing Address - Fax:
Practice Address - Street 1:1371 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14208-1830
Practice Address - Country:US
Practice Address - Phone:510-575-7113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula