Provider Demographics
NPI:1164403283
Name:BANOONI, AMY N (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:N
Last Name:BANOONI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 NORTHPOINT PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-1901
Mailing Address - Country:US
Mailing Address - Phone:561-275-7604
Mailing Address - Fax:561-802-5385
Practice Address - Street 1:770 NORTHPOINT PKWY STE 200
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-1901
Practice Address - Country:US
Practice Address - Phone:561-655-3331
Practice Address - Fax:561-655-3744
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100114207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL52906OtherBCBS OF FLORIDA
FL280843900Medicaid
FL52906OtherBCBS OF FLORIDA
FLAL137ZMedicare PIN