Provider Demographics
NPI:1851061287
Name:CUNNINGHAM, SHANNON CHRISTA
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:CHRISTA
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4938 ANNANDALE LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1304
Mailing Address - Country:US
Mailing Address - Phone:917-715-1102
Mailing Address - Fax:
Practice Address - Street 1:152 CENTER LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1007
Practice Address - Country:US
Practice Address - Phone:516-719-0313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program