Healthcare Provider Details

I. General information

NPI: 1760812457
Provider Name (Legal Business Name): CHERISE CUNNINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 SHIRLEY AVE
BUFFALO NY
14215-1018
US

IV. Provider business mailing address

32 SHIRLEY AVE
BUFFALO NY
14215-1018
US

V. Phone/Fax

Practice location:
  • Phone: 716-602-5606
  • Fax:
Mailing address:
  • Phone: 716-602-5606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number655422-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WD1100X
TaxonomyPeritoneal Dialysis Registered Nurse
License Number655422-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number655422-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number655422-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: