Provider Demographics
NPI:1396503579
Name:CUNNINGHAM, PATRICE SHAYNELLE
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:SHAYNELLE
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 1:10410 FOOTHILL BLVD APT 21
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-5149
Mailing Address - Country:US
Mailing Address - Phone:510-488-8406
Mailing Address - Fax:
Practice Address - Street 1:10410 FOOTHILL BLVD APT 21
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-5149
Practice Address - Country:US
Practice Address - Phone:510-488-8406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty