Healthcare Provider Details

I. General information

NPI: 1760690457
Provider Name (Legal Business Name): PAMELA BONNEY MS, RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 PROSPECT ST SUITE LL3
HUNTINGTON NY
11743-3382
US

IV. Provider business mailing address

86 KENNETH AVE
HUNTINGTON NY
11743-4929
US

V. Phone/Fax

Practice location:
  • Phone: 646-389-0480
  • Fax:
Mailing address:
  • Phone: 646-389-0480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number005023-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number005023-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number005023-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number005023-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number005023-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: