Active NPI
Cyndy Edwards Lively, M.D.
- Pediatrics Physician
- Winston Salem, NC
National Provider Identifier
1215179700
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 26843
- Practice address
- 1417 Brookstown Ave
Winston Salem, NC 27101-1126 - Phone
- (336) 725-7220
- NPI assigned
- Mar 30, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 26843 | NC | Primary |
Addresses
Primary practice location
1417 Brookstown Ave
Winston Salem, NC 27101-1126
Mailing address
1417 Brookstown Ave
Winston Salem, NC 27101-1126
Phone (336) 725-7220
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8901759 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26843 | NC | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1238371200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1238371200000",
"number": "1215179700",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1417 BROOKSTOWN AVE",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271011126",
"telephone_number": "336-725-7220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1417 BROOKSTOWN AVE",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271011126",
"telephone_number": "336-725-7220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIVELY",
"first_name": "CYNDY",
"middle_name": "EDWARDS",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-03-30",
"last_updated": "2009-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NC",
"license": "26843",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8901759",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.