1396748448 NPI number — CYNTHIA YOUNGMAYKA P.A.

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	YOUNGMAYKA
Provider First Name	:	CYNTHIA
Provider Middle Name	:
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Provider Name Suffix Text	:
Provider Credential Text	:	P.A.
Provider Gender Code	:	F

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Provider Other First Name	:
Provider Other Middle Name	:
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NPI Number	:	1396748448
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	09/12/2011
NPI Deactivation Reason Code	:
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Provider First Line Business Mailing Address	:	8100 OSWEGO RD
Provider Second Line Business Mailing Address	:	SUITE 220
Provider Business Mailing Address City Name	:	LIVERPOOL
Provider Business Mailing Address State Name	:	NY
Provider Business Mailing Address Postal Code	:	130901654
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	3156526551
Provider Business Mailing Address Fax Number	:	3156529698

Provider First Line Business Practice Location Address	:	8100 OSWEGO RD
Provider Second Line Business Practice Location Address	:	SUITE 220
Provider Business Practice Location Address City Name	:	LIVERPOOL
Provider Business Practice Location Address State Name	:	NY
Provider Business Practice Location Address Postal Code	:	130901654
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	3156526551
Provider Business Practice Location Address Fax Number	:	3156529698
Provider Enumeration Date	:	05/23/2005

Authorized Official Last Name	:
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• Taxonomy code: 363A00000X , with the licence number:  0040721 , registered in the state of NY .

• Identifier: 01270915 , issued by the state of ( NY ) . This identifiers is of the category "".
• Identifier: R88663 , issued by the state of ( NY ) . This identifiers is of the category "".