Provider Demographics
NPI:1417948209
Name:CUNNINGHAM, PAMELA SHENOUDA (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SHENOUDA
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:EMAD
Other - Last Name:SHENOUDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1808
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-1808
Mailing Address - Country:US
Mailing Address - Phone:432-331-1234
Mailing Address - Fax:432-331-1265
Practice Address - Street 1:600 N GRANT AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4503
Practice Address - Country:US
Practice Address - Phone:432-331-1234
Practice Address - Fax:432-331-1265
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0387207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174108401Medicaid
I09476Medicare UPIN
TX174108401Medicaid