Provider Demographics
NPI:1134221930
Name:CUNNINGHAM, LILLIAN S (RD/LD/N)
Entity type:Individual
Prefix:MS
First Name:LILLIAN
Middle Name:S
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:RD/LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 WESTMINSTER DR
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3053
Mailing Address - Country:US
Mailing Address - Phone:561-965-3625
Mailing Address - Fax:561-965-3625
Practice Address - Street 1:1665 PALM BEACH LAKES BLVD
Practice Address - Street 2:THE FORUM, 9TH FLOOR, SUITE 900
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2121
Practice Address - Country:US
Practice Address - Phone:561-681-2524
Practice Address - Fax:561-681-2501
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR138201133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered