Individual
MELISSA BONILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
501 KINGS HWY E STE 106, FAIRFIELD, CT 06825-4871
(203) 819-1203
Mailing address
501 KINGS HWY E STE 106, FAIRFIELD, CT 06825-4871
(203) 819-1203
(203) 819-1203
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001589
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001589
STATE LICENSE
CT
Enumeration date
07/20/2005
Last updated
04/29/2024
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