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General NPI Number Information
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NPI Number | 1114654621
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Entity Type | Individual
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Provider Name | MELISSA CUNNINGHAM PMHNP
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Gender | Female
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Dates
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Enumeration Date | 08/04/2022
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 100 GANNETT DR
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-5900
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Country | US
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Telephone | 407-484-6919
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Fax | 207-747-4067
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Provider Business Mailing Address
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Address Line | 62 ELM ST
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City | PORTLAND
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State | ME
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Zip | 04101-3091
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Country | US
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Telephone |
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | CNP221413
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License Number State | ME
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