Individual
AMANDA MICHELLE BONASIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A-GNP-C
Contact information
Practice address
9 DERBY PL, KINGS PARK, NY 11754-5107
(631) 338-2433
Mailing address
9 DERBY PL, KINGS PARK, NY 11754-5107
(631) 338-2433
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
310923
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
310923
NYS NP LICENSE
NY
Enumeration date
09/22/2022
Last updated
09/22/2022
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