Healthcare Provider Details

I. General information

NPI: 1598386864
Provider Name (Legal Business Name): SANDRA HOWARD BONAT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 FILOMENA CT
DIX HILLS NY
11746-4750
US

IV. Provider business mailing address

4 FILOMENA CT
DIX HILLS NY
11746-4750
US

V. Phone/Fax

Practice location:
  • Phone: 240-281-6082
  • Fax: 631-500-2976
Mailing address:
  • Phone: 240-281-6082
  • Fax: 631-271-4010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number302696-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: