Provider Demographics
NPI:1255348470
Name:CUNNINGHAM, SEAN J (PA-C)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:J
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PEACH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1423
Mailing Address - Country:US
Mailing Address - Phone:814-877-9100
Mailing Address - Fax:814-454-8470
Practice Address - Street 1:100 PEACH ST STE 400
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1423
Practice Address - Country:US
Practice Address - Phone:814-877-9100
Practice Address - Fax:814-454-8470
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052590363A00000X
NC0010-06102363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103287EMHMedicare PIN
PAQ71244Medicare UPIN