Healthcare Provider Details

I. General information

NPI: 1225769060
Provider Name (Legal Business Name): NICOLE DARRAH CUDDY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 CENTRE AVE STE 415
PITTSBURGH PA
15232-1311
US

IV. Provider business mailing address

624 GEORGETOWN RD
DARLINGTON PA
16115-2708
US

V. Phone/Fax

Practice location:
  • Phone: 412-802-4136
  • Fax:
Mailing address:
  • Phone: 724-777-8265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: