Healthcare Provider Details

I. General information

NPI: 1477125862
Provider Name (Legal Business Name): SYDNEY BUONO RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6859 E REMBRANDT AVE STE 101
MESA AZ
85212-3629
US

IV. Provider business mailing address

PO BOX 258831
OKLAHOMA CITY OK
73125-8831
US

V. Phone/Fax

Practice location:
  • Phone: 480-389-4516
  • Fax:
Mailing address:
  • Phone: 720-961-3764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-001227
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number21175890
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: