Provider Demographics
NPI:1811913411
Name:CUNHA, OLIMPIO F (MD)
Entity type:Individual
Prefix:DR
First Name:OLIMPIO
Middle Name:F
Last Name:CUNHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MIRROR LAKE DR
Mailing Address - Street 2:STE A
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3101
Mailing Address - Country:US
Mailing Address - Phone:386-673-2500
Mailing Address - Fax:386-673-3204
Practice Address - Street 1:8 MIRROR LAKE DR
Practice Address - Street 2:STE A
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-3101
Practice Address - Country:US
Practice Address - Phone:386-673-2500
Practice Address - Fax:386-673-3204
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059172174400000X
FLME0591722084D0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic Neuroimaging
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052590100Medicaid
FL05259010Medicaid
FLB82895Medicare UPIN
11768XMedicare PIN
FL05259010Medicaid