Provider Demographics
NPI:1942526322
Name:CUNNINGHAM, SHANI (DO)
Entity type:Individual
Prefix:
First Name:SHANI
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 LEE RD STE 165
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2127
Mailing Address - Country:US
Mailing Address - Phone:407-975-0410
Mailing Address - Fax:407-975-0411
Practice Address - Street 1:601 E ROLLINS ST
Practice Address - Street 2:FLORIDA HOSPITAL PEDIATRIC HOSPITALISTS
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1248
Practice Address - Country:US
Practice Address - Phone:407-975-0410
Practice Address - Fax:407-975-0411
Is Sole Proprietor?:No
Enumeration Date:2010-04-11
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4185208000000X
TXN4998208000000X
FLOS12051208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA19242526322Medicaid
FL009381200Medicaid
IA719260230Medicare PIN