Healthcare Provider Details

I. General information

NPI: 1548004567
Provider Name (Legal Business Name): SARA CUNNINGHAM PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 APPLETREE LN
CLIFTON PARK NY
12065-2106
US

IV. Provider business mailing address

84 APPLETREE LN
CLIFTON PARK NY
12065-2106
US

V. Phone/Fax

Practice location:
  • Phone: 716-217-8826
  • Fax:
Mailing address:
  • Phone: 716-217-8826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number026342
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: