Provider Demographics
NPI:1609873140
Name:BUNYI, JESINIO S (MD)
Entity Type:Individual
Prefix:DR
First Name:JESINIO
Middle Name:S
Last Name:BUNYI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 W SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5435
Mailing Address - Country:US
Mailing Address - Phone:954-473-2128
Mailing Address - Fax:954-476-6836
Practice Address - Street 1:8320 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5435
Practice Address - Country:US
Practice Address - Phone:954-473-2128
Practice Address - Fax:954-476-6836
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042897208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063183Medicare UPIN
FL94280Medicare ID - Type Unspecified