Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 172845 | NY |
NPI | 1164591962 |
---|---|
Provider Name | Dr. Sandra Jane Cunningham |
First Address | New York, NY 10028-7512 |
Second Address | Bronx, NY 10461-1138 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01846900 | (05) | NY |