Provider Demographics
NPI:1730424607
Name:JACUNSKI, CYNTHIA C (EDD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:C
Last Name:JACUNSKI
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:DR
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:SUOZZI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD
Mailing Address - Street 1:2805 STANLEY RD
Mailing Address - Street 2:
Mailing Address - City:MATTITUCK
Mailing Address - State:NY
Mailing Address - Zip Code:11952-2733
Mailing Address - Country:US
Mailing Address - Phone:631-813-7094
Mailing Address - Fax:
Practice Address - Street 1:2805 STANLEY RD
Practice Address - Street 2:
Practice Address - City:MATTITUCK
Practice Address - State:NY
Practice Address - Zip Code:11952-2733
Practice Address - Country:US
Practice Address - Phone:631-813-7094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY538353174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY538353OtherPUBLIC SCHOOL TEACHER CERTIFICATE