Provider Demographics
NPI:1871781146
Name:CYNTHIA D HENSLEY MD INC
Entity type:Organization
Organization Name:CYNTHIA D HENSLEY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-390-9933
Mailing Address - Street 1:26661 DUBLIN WOODS CIR
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-7224
Mailing Address - Country:US
Mailing Address - Phone:239-390-9933
Mailing Address - Fax:239-390-2095
Practice Address - Street 1:26661 DUBLIN WOODS CIR
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-7224
Practice Address - Country:US
Practice Address - Phone:239-390-9933
Practice Address - Fax:239-390-2095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79598261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2266Medicare UPIN