Healthcare Provider Details

I. General information

NPI: 1073402574
Provider Name (Legal Business Name): AMY BONOMO AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 ARAPAHOE AVE STE 130
BOULDER CO
80303-1082
US

IV. Provider business mailing address

3736 MARIPOSA ST
DENVER CO
80211-2648
US

V. Phone/Fax

Practice location:
  • Phone: 303-443-2771
  • Fax:
Mailing address:
  • Phone: 570-582-4063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1348
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: