Provider Demographics
NPI:1740229822
Name:CUNHA, ANDREA ROSE (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:ROSE
Last Name:CUNHA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793
Mailing Address - Country:US
Mailing Address - Phone:516-526-1661
Mailing Address - Fax:516-826-4695
Practice Address - Street 1:2317A CENTRE AVE
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710
Practice Address - Country:US
Practice Address - Phone:516-221-4311
Practice Address - Fax:516-826-4695
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005791213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU96427Medicare UPIN
NYPH7551Medicare ID - Type Unspecified