Provider Demographics
NPI:1336947407
Name:DAVIS, CYNTHIA IVELISSE (MSN, RN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:IVELISSE
Last Name:DAVIS
Suffix:
Gender:
Credentials:MSN, RN
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:IVELISSE
Other - Last Name:MENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:235 WELLESLEY ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-1571
Mailing Address - Country:US
Mailing Address - Phone:781-768-7000
Mailing Address - Fax:
Practice Address - Street 1:235 WELLESLEY ST STE 1
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-1571
Practice Address - Country:US
Practice Address - Phone:781-768-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2318895163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult