Provider Demographics
NPI:1063553576
Name:CUNNINGHAM, SHEILA ANNE
Entity type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:ANNE
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 1:13 CHARLESTON CT
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-1606
Mailing Address - Country:US
Mailing Address - Phone:631-928-8362
Mailing Address - Fax:631-928-8362
Practice Address - Street 1:13 CHARLESTON CT
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-1606
Practice Address - Country:US
Practice Address - Phone:631-928-8362
Practice Address - Fax:631-928-8362
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008005-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist