Provider Demographics
NPI:1740581818
Name:CUNNINGHAM, STACY MICHELLE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:MICHELLE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 NEWMAN ST
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2327
Mailing Address - Country:US
Mailing Address - Phone:732-662-4711
Mailing Address - Fax:
Practice Address - Street 1:850 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2021
Practice Address - Country:US
Practice Address - Phone:917-608-7337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012224-1235Z00000X
NJ00276986235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist