Provider Demographics
NPI:1841842622
Name:CUNETTA, MARISSA (PA-C)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:CUNETTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-5237
Mailing Address - Country:US
Mailing Address - Phone:401-239-1800
Mailing Address - Fax:401-239-1801
Practice Address - Street 1:102 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-5237
Practice Address - Country:US
Practice Address - Phone:401-239-1800
Practice Address - Fax:401-239-1801
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X, 390200000X
RIPA01228363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty