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General NPI Number Information
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NPI Number | 1104983212
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Entity Type | Individual
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Provider Name | NICOLE THERESA BUONANNO PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9 LIVINGSTON STREET SUITE 5 - DR. KUCHEROV
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City | POUGHKEEPSIE
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State | NY
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Zip | 12601
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Country | US
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Telephone | 845-454-0728
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Fax | 845-454-0914
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Provider Business Mailing Address
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Address Line | 4023 THOMAS PAINE WAY
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City | NEW WINDSOR
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State | NY
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Zip | 12553
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Country | US
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Telephone | 845-821-3818
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Fax | 845-454-0914
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 010169-1
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License Number State | NY
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