Individual
TIFFANY LEE BONAFE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2101 W ARLINGTON BLVD STE 210, GREENVILLE, NC 27834-5758
(252) 931-7638
Mailing address
PO BOX 30750, GREENVILLE, NC 27833-0750
(252) 931-7638
(252) 931-7694
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
2018-00858
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/17/2012
Last updated
04/11/2022
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