Individual
SHANNON M CUNNINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
8501 ARLINGTON BLVD, SUITE 550, FAIRFAX, VA 22032-4625
(703) 810-5219
(703) 810-5406
Mailing address
PO BOX 71230, PHILADELPHIA, PA 19176-6230
(703) 383-6469
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R083823
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4191757 00
—
MD
01
—
430074296
RR MEDICARE
MD
01
—
KBC1CH
CAREFIRST BCBS
MD
01
—
S417-0011
CAREFIRST BCBS
DC
Enumeration date
11/04/2005
Last updated
01/25/2012
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