Provider Demographics
NPI:1619014693
Name:BUONORA, AMANDA DENISE (PT)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:DENISE
Last Name:BUONORA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:DENISE
Other - Last Name:JUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3030 CLOVERMERE RD
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-2532
Mailing Address - Country:US
Mailing Address - Phone:516-679-8551
Mailing Address - Fax:
Practice Address - Street 1:3030 CLOVERMERE RD
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2532
Practice Address - Country:US
Practice Address - Phone:516-679-8551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015406225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist