Provider Demographics
NPI:1962755603
Name:SANDER TERRY, CYNTHIA D (STNA)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:D
Last Name:SANDER TERRY
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:DENISE
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:STNA
Mailing Address - Street 1:915 CAMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:VLEVELNAD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121
Mailing Address - Country:US
Mailing Address - Phone:216-213-1334
Mailing Address - Fax:
Practice Address - Street 1:915 CAMBRIDGE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44121
Practice Address - Country:US
Practice Address - Phone:216-213-1334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH379834360501376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide