Provider Demographics
NPI:1285608232
Name:SLY, CYNTHIA J (ANP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:SLY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:J
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3366 OAKDALE AVE NO
Mailing Address - Street 2:#315 NORTH CLINIC, PA
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422
Mailing Address - Country:US
Mailing Address - Phone:763-587-7900
Mailing Address - Fax:763-587-7989
Practice Address - Street 1:3366 OAKDALE AVENUE NORTH
Practice Address - Street 2:SUITE 315
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422
Practice Address - Country:US
Practice Address - Phone:763-587-7900
Practice Address - Fax:763-587-7989
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1052688363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN564158600Medicaid
MN564158600Medicaid
500002999Medicare ID - Type Unspecified