Provider Demographics
NPI:1295406387
Name:MINOR, QUNEETSHA BONITA
Entity Type:Individual
Prefix:
First Name:QUNEETSHA
Middle Name:BONITA
Last Name:MINOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 ASTORIA BLVD APT 2G
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-5200
Mailing Address - Country:US
Mailing Address - Phone:718-880-0862
Mailing Address - Fax:
Practice Address - Street 1:104 ASTORIA BLVD APT 2G
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-5200
Practice Address - Country:US
Practice Address - Phone:718-880-0862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program