Provider Demographics
NPI:1649515727
Name:CUNNINGHAM, RACHEL D (PA)
Entity type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:D
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 W 68TH ST
Mailing Address - Street 2:APT 5A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5304
Mailing Address - Country:US
Mailing Address - Phone:516-526-8990
Mailing Address - Fax:
Practice Address - Street 1:77 W 68TH ST
Practice Address - Street 2:APT 5A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5304
Practice Address - Country:US
Practice Address - Phone:516-526-8990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical