Provider Demographics
NPI:1336658046
Name:DAYTON, BONNIE F (MED)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:F
Last Name:DAYTON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 MOUNTAIN AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-3838
Mailing Address - Country:US
Mailing Address - Phone:540-529-5863
Mailing Address - Fax:
Practice Address - Street 1:610 MOUNTAIN AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-3838
Practice Address - Country:US
Practice Address - Phone:540-529-5863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency