Provider Demographics
NPI:1689422693
Name:CUNIC, TANYA L (PSYD)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:L
Last Name:CUNIC
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 SASSAFRAS HILL ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-3708
Mailing Address - Country:US
Mailing Address - Phone:919-824-2027
Mailing Address - Fax:
Practice Address - Street 1:1704 SASSAFRAS HILL ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27712-3708
Practice Address - Country:US
Practice Address - Phone:919-824-2027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041823A103TC0700X
NC6297103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical