Individual ProviderCynthia Louise SproulLicensed Practical NurseNursing Service ProvidersPractice Address20 Holbrook Street, Patchogue, NY 11772-1616(631) 654-4050PECOS EnrollmentBased on the most recent information from CMS, provider Cynthia Louise Sproul does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1295928372Provider TypeIndividualFull NameSproul, Cynthia LouiseTitleMs.CredentialLPNGenderFemaleSole ProprietorYesEnumeration Date8/22/2007Last Updated8/22/2007Contact InformationPractice LocationPractice Address20 Holbrook Street, Patchogue, NY 11772-1616Phone(631) 654-4050FaxUnlisted FaxMailing LocationMailing Address20 Holbrook Street, Patchogue, NY 11772-1616Phone(631) 654-4050FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode164W00000XPrimaryDescriptionLicensed Practical NurseNursing Service ProvidersLicense2810371New YorkProvider IdentifiersIDDescriptionIssuerID02753780DescriptionMedicaidIssuerUnlistedNew York