Individual
SHANTEYA CUNNINGHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3481 ROBB AVE, CINCINNATI, OH 45211-5340
(513) 709-2191
Mailing address
3481 ROBB AVE, CINCINNATI, OH 45211-5340
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102358072-00
CARE SOURCE
—
Enumeration date
06/29/2018
Last updated
06/11/2019
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