Provider Demographics
NPI:1225769060
Name:CUDDY, NICOLE DARRAH (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DARRAH
Last Name:CUDDY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16115-2708
Mailing Address - Country:US
Mailing Address - Phone:724-777-8265
Mailing Address - Fax:
Practice Address - Street 1:5200 CENTRE AVE STE 415
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1311
Practice Address - Country:US
Practice Address - Phone:412-802-4136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant