Provider Demographics
NPI:1194496794
Name:BROWN-CUNNINGHAM, ANDREANA HARIESHA
Entity type:Individual
Prefix:
First Name:ANDREANA
Middle Name:HARIESHA
Last Name:BROWN-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 1:130 S PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14614-2209
Mailing Address - Country:US
Mailing Address - Phone:585-753-4085
Mailing Address - Fax:
Practice Address - Street 1:130 S PLYMOUTH AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14614-2209
Practice Address - Country:US
Practice Address - Phone:585-753-4085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY732581163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse