Healthcare Provider Details

I. General information

NPI: 1437475407
Provider Name (Legal Business Name): BONNIE MELISSA CEFALU DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4960 OLD CANTON RD.
JACKSON MS
39211
US

IV. Provider business mailing address

4960 OLD CANTON RD.
JACKSON MS
39211
US

V. Phone/Fax

Practice location:
  • Phone: 601-956-6144
  • Fax: 601-956-6145
Mailing address:
  • Phone: 601-956-6144
  • Fax: 601-956-6145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberT1820
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: