Provider Demographics
NPI:1548521172
Name:FAGELLA, CYNTHIA ANN
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:FAGELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 UNION VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-3943
Mailing Address - Country:US
Mailing Address - Phone:845-628-4501
Mailing Address - Fax:
Practice Address - Street 1:476 UNION VALLEY RD
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-3943
Practice Address - Country:US
Practice Address - Phone:845-628-4501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352328-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse