Provider Demographics
NPI:1134704281
Name:YENSHAW, BONNI JEANNE MARIE (ENVIRONMENT SERVICES)
Entity Type:Individual
Prefix:
First Name:BONNI
Middle Name:JEANNE MARIE
Last Name:YENSHAW
Suffix:
Gender:F
Credentials:ENVIRONMENT SERVICES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4736 OCEANIA ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3219
Mailing Address - Country:US
Mailing Address - Phone:917-605-3115
Mailing Address - Fax:
Practice Address - Street 1:20980 45TH DR
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3232
Practice Address - Country:US
Practice Address - Phone:917-605-3115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4881872171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY811147594Medicaid