Provider Demographics
NPI:1225027337
Name:HENRY, CYNTHIA LAVERY (DO)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LAVERY
Last Name:HENRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 AUBURN DR.
Mailing Address - Street 2:STE.350
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4327
Mailing Address - Country:US
Mailing Address - Phone:440-646-1600
Mailing Address - Fax:440-646-1505
Practice Address - Street 1:36855 AMERICAN WAY
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-4054
Practice Address - Country:US
Practice Address - Phone:440-696-7546
Practice Address - Fax:440-268-4406
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008695207N00000X
OH34.008695207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2625243Medicaid
OH2625243Medicaid
OH4175641Medicare PIN
OH4175642Medicare PIN