MEDICARE: CAYLLA LEIGH 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	110743	NY

General Provider Information

NPI Number	:	1598345282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAYLLA LEIGH CUNNINGHAM

Provider Business Mailing Address
First Line	:	183 WASHINGTON AVE
Second Line	:
City	:	EAST PATCHOGUE
State	:	NY
Zip	:	11772-2756
Country	:	US
Telephone Number	:	631-487-8765
Fax Number	:

Provider Business Practice Location Address
First Line	:	94 W MAIN ST STE 200
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8365
Country	:	US
Telephone Number	:	631-252-2820
Fax Number	:

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

Provider Enumeration Date	:	04/08/2021
Last Update Date	:	04/08/2021

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Directions to “ CAYLLA LEIGH CUNNINGHAM ” Practice Location

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