Provider Demographics
NPI:1205893773
Name:CYRIAC, PREETHY (PA)
Entity type:Individual
Prefix:
First Name:PREETHY
Middle Name:
Last Name:CYRIAC
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2300 COMPUTER RD
Mailing Address - Street 2:SUITE H-39
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1752
Mailing Address - Country:US
Mailing Address - Phone:215-657-5200
Mailing Address - Fax:
Practice Address - Street 1:4755 OGLETOWN STANTON ROAD
Practice Address - Street 2:SUITE 5A43
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-2200
Practice Address - Country:US
Practice Address - Phone:302-623-0188
Practice Address - Fax:302-733-5640
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2024-09-24
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Provider Licenses
StateLicense IDTaxonomies
DEC5-0012094363A00000X
MDC0009539363A00000X
PAMA051963363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA420211Medicare PIN