Provider Demographics
NPI:1881767580
Name:EARL, CYNTHIA SHAWN (PAC MMS)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:SHAWN
Last Name:EARL
Suffix:
Gender:F
Credentials:PAC MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6341 CARVER OAKS DR APT 1212
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-8974
Mailing Address - Country:US
Mailing Address - Phone:202-213-9815
Mailing Address - Fax:910-822-7970
Practice Address - Street 1:2300 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-3856
Practice Address - Country:US
Practice Address - Phone:910-488-2120
Practice Address - Fax:910-822-7970
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC02082363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical