MEDICARE: ANDREA CUNNINGHAM PA-C

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	363A00000X	Physician Assistant	014951	NY
2	363A00000X	Physician Assistant	3415	CT

General Provider Information

NPI Number	:	1780962514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA CUNNINGHAM PA-C

Provider Business Mailing Address
First Line	:	1427 CHAPEL ST
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-4403
Country	:	US
Telephone Number	:	203-865-3880
Fax Number	:

Provider Business Practice Location Address
First Line	:	1427 CHAPEL ST
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-4403
Country	:	US
Telephone Number	:	203-865-3880
Fax Number	:

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

Provider Enumeration Date	:	07/27/2011
Last Update Date	:	12/09/2015

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