Provider Demographics
NPI:1184145492
Name:CUNNINGHAM, SHANA CHRISTIAN (MSN, RN, BC-ADM, CDE)
Entity type:Individual
Prefix:MS
First Name:SHANA
Middle Name:CHRISTIAN
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MSN, RN, BC-ADM, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 SOUTH LIMESTONE, UNIVERSITY HEALTH SERVICES BLDG
Mailing Address - Street 2:BARNESSTABLE BROWN DIABETES CENTER, 4TH FLOOR
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536
Mailing Address - Country:US
Mailing Address - Phone:859-323-5407
Mailing Address - Fax:859-257-0487
Practice Address - Street 1:2195 HARRODSBURG RD STE 125
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3504
Practice Address - Country:US
Practice Address - Phone:859-323-2232
Practice Address - Fax:859-257-0659
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1105645163W00000X
KY129960163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163W00000XNursing Service ProvidersRegistered Nurse