Provider Demographics
NPI:1598386864
Name:BONAT, SANDRA HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:HOWARD
Last Name:BONAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 FILOMENA CT
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4750
Mailing Address - Country:US
Mailing Address - Phone:240-281-6082
Mailing Address - Fax:631-271-4010
Practice Address - Street 1:4 FILOMENA CT
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-4750
Practice Address - Country:US
Practice Address - Phone:240-281-6082
Practice Address - Fax:631-271-4010
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302696-01208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty