Provider Demographics
NPI:1275593576
Name:ANDERSON, CYNTHIA W (ANP)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:W
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SIGMA DR
Mailing Address - Street 2:STE 100
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-7715
Mailing Address - Country:US
Mailing Address - Phone:843-569-1856
Mailing Address - Fax:843-569-1879
Practice Address - Street 1:9313 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 310
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9155
Practice Address - Country:US
Practice Address - Phone:843-569-1856
Practice Address - Fax:843-569-1879
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1064363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01584163OtherRR MEDICARE
SCNP1324Medicaid
SCP01584163OtherRR MEDICARE
SCR862045551Medicare PIN
SCNP1324Medicaid