Healthcare Provider Details

I. General information

NPI: 1437069713
Provider Name (Legal Business Name): KATIE SARAH CUNNINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12823 SOLOLA WAY
TRINITY FL
34655-7246
US

IV. Provider business mailing address

1305 HALAPA WAY
TRINITY FL
34655-7232
US

V. Phone/Fax

Practice location:
  • Phone: 727-505-9949
  • Fax:
Mailing address:
  • Phone: 727-359-5267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: