Provider Demographics
NPI:1639471642
Name:CHINDAMO, BONNIE SUSAN (NP)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:SUSAN
Last Name:CHINDAMO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 EAST MAIN STREET
Mailing Address - Street 2:BUILDING 2, SUITE 11
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2800
Mailing Address - Country:US
Mailing Address - Phone:631-859-9793
Mailing Address - Fax:
Practice Address - Street 1:369 E MAIN ST
Practice Address - Street 2:BUILDING 2, SUITE 11
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2800
Practice Address - Country:US
Practice Address - Phone:631-859-9793
Practice Address - Fax:631-277-4608
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301427-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner