MEDICARE: MS. EVONY CUNNINGHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	108834	TX

General Provider Information

NPI Number	:	1093430589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EVONY CUNNINGHAM

Provider Business Mailing Address
First Line	:	4311 STILLWATER VALLEY CT
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-2068
Country	:	US
Telephone Number	:	251-508-1098
Fax Number	:

Provider Business Practice Location Address
First Line	:	4311 STILLWATER VALLEY CT
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-2068
Country	:	US
Telephone Number	:	251-508-1098
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2022
Last Update Date	:	10/06/2022

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