Provider Demographics
NPI:1487981114
Name:AEBY, CYNTHIA ELAINE (DOM, LAC)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:ELAINE
Last Name:AEBY
Suffix:
Gender:F
Credentials:DOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12324 CANDELARIA RD NE APT 2
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2158
Mailing Address - Country:US
Mailing Address - Phone:512-431-2287
Mailing Address - Fax:
Practice Address - Street 1:2509 VERMONT ST NE STE A2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4600
Practice Address - Country:US
Practice Address - Phone:505-266-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDOM23001171100000X
TXAC00990171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist