Healthcare Provider Details

I. General information

NPI: 1871266262
Provider Name (Legal Business Name): GENNADIY BONDARCHUK MSN, APRN-CNP, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18901 LAKESHORE BLVD
EUCLID OH
44119-1078
US

IV. Provider business mailing address

9500 EUCLID AVE MAIL CODE EU-291P
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-531-9000
  • Fax:
Mailing address:
  • Phone: 216-440-5086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0029417
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: