Provider Demographics
NPI:1316900418
Name:POWELL, CYNTHIA K (MD)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:K
Last Name:POWELL
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 1:4200 SUN N LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-1986
Mailing Address - Country:US
Mailing Address - Phone:863-402-3103
Mailing Address - Fax:863-382-1433
Practice Address - Street 1:4200 SUN N LAKE BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-1986
Practice Address - Country:US
Practice Address - Phone:863-402-3103
Practice Address - Fax:863-382-1433
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL25622080N0001X
FLME 1262582080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL2562OtherSTATE LICENSE NUMBER
FLME 126258OtherSTATE LICENSE