Provider Demographics
NPI:1346592896
Name:SIKES, BONNIE ANN (MAED)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:ANN
Last Name:SIKES
Suffix:
Gender:F
Credentials:MAED
Other - Prefix:MISS
Other - First Name:BONNIE
Other - Middle Name:ANN
Other - Last Name:WINGERTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:83 PARKSIDE CT
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1052
Mailing Address - Country:US
Mailing Address - Phone:716-248-5744
Mailing Address - Fax:
Practice Address - Street 1:4635 UNION RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14225-1851
Practice Address - Country:US
Practice Address - Phone:716-505-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist