Provider Demographics
NPI:1568421857
Name:CUNNINGHAM, MELODY J (MD)
Entity Type:Individual
Prefix:DR
First Name:MELODY
Middle Name:J
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 HARBOR BEND RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-0803
Mailing Address - Country:US
Mailing Address - Phone:901-527-2890
Mailing Address - Fax:
Practice Address - Street 1:50 N DUNLAP ST
Practice Address - Street 2:ROOM 289R
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2800
Practice Address - Country:US
Practice Address - Phone:901-287-4619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA155349207ZB0001X, 2080P0207X
TN415102080H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA114260Medicaid
H34349Medicare UPIN