Provider Demographics
NPI:1144812843
Name:BUONDELMONTE, NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BUONDELMONTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8282 LUCHSINGER LN
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-8966
Mailing Address - Country:US
Mailing Address - Phone:908-894-3060
Mailing Address - Fax:
Practice Address - Street 1:1180 N INDIAN CANYON DR STE W214
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4857
Practice Address - Country:US
Practice Address - Phone:760-416-4545
Practice Address - Fax:760-416-4543
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant