Provider Demographics
NPI:1326893827
Name:CUNNINGHAM, SHANNON ELYSE
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ELYSE
Last Name:CUNNINGHAM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 N RAVENSWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4510
Mailing Address - Country:US
Mailing Address - Phone:773-561-7500
Mailing Address - Fax:773-561-7612
Practice Address - Street 1:4600 N RAVENSWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4510
Practice Address - Country:US
Practice Address - Phone:773-561-7500
Practice Address - Fax:773-561-7612
Is Sole Proprietor?:No
Enumeration Date:2024-04-19
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program