Provider Demographics
NPI:1588203707
Name:BUENO, MONICA ALEXANDRA (NP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:ALEXANDRA
Last Name:BUENO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11050 71ST RD STE 1B
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4929
Mailing Address - Country:US
Mailing Address - Phone:718-268-1458
Mailing Address - Fax:
Practice Address - Street 1:11050 71ST RD STE 1B
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4929
Practice Address - Country:US
Practice Address - Phone:718-268-1458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF309216-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health