Provider Demographics
NPI:1538836457
Name:BONA, SHASTA MAY MONTANA
Entity type:Individual
Prefix:
First Name:SHASTA
Middle Name:MAY MONTANA
Last Name:BONA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 614
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01262-0614
Mailing Address - Country:US
Mailing Address - Phone:413-441-1941
Mailing Address - Fax:413-528-0295
Practice Address - Street 1:141 WEST AVE
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1811
Practice Address - Country:US
Practice Address - Phone:413-528-0298
Practice Address - Fax:413-528-0295
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker