Healthcare Provider Details

I. General information

NPI: 1083527543
Provider Name (Legal Business Name): SANYAH NICOLE BONNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MOUNT CONNESS WAY 1892 ANTIOCH CA
ANTIOCH CA
94531
US

IV. Provider business mailing address

MOUNT CONNESS WAY 1892 ANTIOCH CA
ANTIOCH CA
94531
US

V. Phone/Fax

Practice location:
  • Phone: 510-760-4034
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: