Healthcare Provider Details

I. General information

NPI: 1205549508
Provider Name (Legal Business Name): ANGELINA BONTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 01/02/2023
Certification Date: 12/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 OLD NEW MILFORD RD
BROOKFIELD CT
06804-2430
US

IV. Provider business mailing address

77 HOWARD AVE
SOUTHINGTON CT
06489-4739
US

V. Phone/Fax

Practice location:
  • Phone: 203-775-6205
  • Fax:
Mailing address:
  • Phone: 908-235-6255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: