Provider Demographics
NPI:1144389313
Name:BONANNO, ELIZABETH SHARPLESS (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SHARPLESS
Last Name:BONANNO
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Gender:F
Credentials:MD
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Mailing Address - Street 1:30 E BROAD ST
Mailing Address - Street 2:11TH FLOOR
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-3414
Mailing Address - Country:US
Mailing Address - Phone:614-466-6583
Mailing Address - Fax:614-995-3268
Practice Address - Street 1:2611 WAYNE AVE
Practice Address - Street 2:BUILDING #66
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420-1833
Practice Address - Country:US
Practice Address - Phone:937-258-0440
Practice Address - Fax:937-258-6235
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
OH35078623-B2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBB9225841OtherDEA
OHBB9225841OtherDEA