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General NPI Number Information
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NPI Number | 1053144345
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Entity Type | Individual
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Provider Name | WESLEY CUNNINGHAM
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Gender | Male
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Dates
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Enumeration Date | 08/22/2024
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 1525 W. CYPRESS CREEK RD
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309
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Country | US
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Telephone | 954-939-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 4241 SW 21ST ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33317-6305
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Country | US
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Telephone | 615-517-5444
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Fax | 615-517-5444
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | 13079
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License Number State | GA
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