Provider Demographics
NPI:1164824694
Name:THONY, BENDJI
Entity Type:Individual
Prefix:
First Name:BENDJI
Middle Name:
Last Name:THONY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BENDJI
Other - Middle Name:
Other - Last Name:THONY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:806 29TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-3143
Mailing Address - Country:US
Mailing Address - Phone:941-749-5588
Mailing Address - Fax:
Practice Address - Street 1:806 29TH ST CT E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208
Practice Address - Country:US
Practice Address - Phone:941-749-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9358089363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily