Healthcare Provider Details

I. General information

NPI: 1942526322
Provider Name (Legal Business Name): SHANI CUNNINGHAM D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2010
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST FLORIDA HOSPITAL PEDIATRIC HOSPITALISTS
ORLANDO FL
32803-1248
US

IV. Provider business mailing address

1801 LEE RD STE 165
WINTER PARK FL
32789-2127
US

V. Phone/Fax

Practice location:
  • Phone: 407-975-0410
  • Fax: 407-975-0411
Mailing address:
  • Phone: 407-975-0410
  • Fax: 407-975-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4185
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN4998
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS12051
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: