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General NPI Number Information
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NPI Number | 1457988735
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Entity Type | Individual
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Provider Name | DERVIN JUNIOR CUNNINGHAM MD
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Gender | Male
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Dates
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Enumeration Date | 03/25/2020
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 243 TRESSER BLVD FL 17
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City | STAMFORD
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State | CT
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Zip | 06901-3436
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Country | US
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Telephone | 860-756-0455
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Fax |
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Provider Business Mailing Address
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Address Line | 856 QUINNIPIAC AVE APT 5
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City | NEW HAVEN
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State | CT
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Zip | 06513-3362
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Country | US
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Telephone | 229-206-1239
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 72224
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License Number State | CT
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