Healthcare Provider Details

I. General information

NPI: 1205701554
Provider Name (Legal Business Name): SHANEKA CUNNINGHAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 NE 4TH TER
FLORIDA CITY FL
33034-3280
US

IV. Provider business mailing address

557 NE 4TH TER
FLORIDA CITY FL
33034-3280
US

V. Phone/Fax

Practice location:
  • Phone: 786-683-9525
  • Fax: 786-683-9525
Mailing address:
  • Phone: 786-683-9525
  • Fax: 786-683-9525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number9525893
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: