Provider Demographics
NPI:1902257280
Name:CUNNING, COLLYN
Entity Type:Individual
Prefix:
First Name:COLLYN
Middle Name:
Last Name:CUNNING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-5338
Mailing Address - Country:US
Mailing Address - Phone:215-361-5090
Mailing Address - Fax:215-412-4296
Practice Address - Street 1:1019 S BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-5338
Practice Address - Country:US
Practice Address - Phone:215-361-5090
Practice Address - Fax:215-412-4296
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058224363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical