Healthcare Provider Details

I. General information

NPI: 1730820689
Provider Name (Legal Business Name): DEMETRA MENSAH-BONSU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

2835 RIDGE MANOR DR
DACULA GA
30019-2778
US

V. Phone/Fax

Practice location:
  • Phone: 585-756-4800
  • Fax:
Mailing address:
  • Phone: 678-790-6306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: