Provider Demographics
NPI:1720501133
Name:RODRIGUEZ, CYNTHIA INDIRA (MSED)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:INDIRA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-5902
Mailing Address - Country:US
Mailing Address - Phone:718-386-3242
Mailing Address - Fax:718-386-4444
Practice Address - Street 1:292 PALMETTO ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-5902
Practice Address - Country:US
Practice Address - Phone:718-386-3242
Practice Address - Fax:718-386-4444
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist