Provider Demographics
NPI:1134183718
Name:HENSLEY, CYNTHIA D (MD, PA)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:D
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26661 DUBLIN WOODS CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135
Mailing Address - Country:US
Mailing Address - Phone:239-390-9933
Mailing Address - Fax:239-390-2095
Practice Address - Street 1:26661 DUBLIN WOODS CIRCLE
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135
Practice Address - Country:US
Practice Address - Phone:239-390-9933
Practice Address - Fax:239-390-2095
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044232207NS0135X
FLME79598207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35789OtherBLUE CROSS BLUE SHIELD FL
FL070014768OtherRAILROAD MEDICARE
FLK2266Medicare ID - Type Unspecified
FLH14043Medicare UPIN