Healthcare Provider Details

I. General information

NPI: 1689422693
Provider Name (Legal Business Name): TANYA L CUNIC PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 SASSAFRAS HILL ST
DURHAM NC
27712-3708
US

IV. Provider business mailing address

1704 SASSAFRAS HILL ST
DURHAM NC
27712-3708
US

V. Phone/Fax

Practice location:
  • Phone: 919-824-2027
  • Fax:
Mailing address:
  • Phone: 919-824-2027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20041823A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6297
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number6297
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: