Provider Demographics
NPI:1528221223
Name:CUNY, LEEANN MARIE (DO)
Entity type:Individual
Prefix:
First Name:LEEANN
Middle Name:MARIE
Last Name:CUNY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 TUOLUMNE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-4638
Mailing Address - Country:US
Mailing Address - Phone:707-656-3453
Mailing Address - Fax:855-225-6308
Practice Address - Street 1:805 TUOLUMNE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590
Practice Address - Country:US
Practice Address - Phone:707-656-3453
Practice Address - Fax:855-225-6308
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12304204D00000X
ME390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program