Healthcare Provider Details

I. General information

NPI: 1831024074
Provider Name (Legal Business Name): KEVIN BUONANNI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 MAIN ST
MERIDEN CT
06451-5149
US

IV. Provider business mailing address

49 EVANSVILLE AVE
MERIDEN CT
06451-5132
US

V. Phone/Fax

Practice location:
  • Phone: 203-988-3631
  • Fax:
Mailing address:
  • Phone: 203-988-3631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6903
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: