Healthcare Provider Details

I. General information

NPI: 1619882040
Provider Name (Legal Business Name): TERRI MICHELLE CUNNINGHAM ROSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 PGA BLVD STE 600
PALM BEACH GARDENS FL
33410-6542
US

IV. Provider business mailing address

842 NW GREENWICH CT
PORT ST LUCIE FL
34983-3403
US

V. Phone/Fax

Practice location:
  • Phone: 561-507-7028
  • Fax:
Mailing address:
  • Phone: 561-507-7028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: