Provider Demographics
NPI:1265687420
Name:CUNNINGHAM, SHAMEIKA PATRICE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SHAMEIKA
Middle Name:PATRICE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 ILYSSA WAY
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1374
Mailing Address - Country:US
Mailing Address - Phone:917-459-7959
Mailing Address - Fax:
Practice Address - Street 1:632 ILYSSA WAY
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-1374
Practice Address - Country:US
Practice Address - Phone:917-459-7959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker