Provider Demographics
NPI:1952605073
Name:CUNNINGHAM, TERRY ANNE
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:ANNE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:THERESA
Other - Middle Name:ANNE
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4 DARTMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209-1302
Mailing Address - Country:US
Mailing Address - Phone:518-275-3388
Mailing Address - Fax:
Practice Address - Street 1:4 DARTMOUTH ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12209-1302
Practice Address - Country:US
Practice Address - Phone:518-275-3388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153015862174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY156989996OtherNEW YORK STATE DRIVER'S LICENSE