Provider Demographics
NPI:1366400210
Name:SHIRLEY, CYNTHIA A (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:A
Last Name:SHIRLEY
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 1:2300 S CLEAR CREEK RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-4984
Mailing Address - Country:US
Mailing Address - Phone:254-519-2192
Mailing Address - Fax:254-519-2176
Practice Address - Street 1:2300 S CLEAR CREEK RD
Practice Address - Street 2:SUITE 202
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4984
Practice Address - Country:US
Practice Address - Phone:254-519-2192
Practice Address - Fax:254-519-2176
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD073270L207V00000X
TXM3735207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187313501Medicaid
PA001850619Medicaid
H49812Medicare UPIN
TX187313501Medicaid
TX8JR233Medicare PIN