Provider Demographics
NPI:1629356266
Name:BONURA, DEVIN M (PA-C)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:M
Last Name:BONURA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-3104
Mailing Address - Country:US
Mailing Address - Phone:631-667-0388
Mailing Address - Fax:631-968-7705
Practice Address - Street 1:1231 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-3104
Practice Address - Country:US
Practice Address - Phone:631-667-0388
Practice Address - Fax:631-968-7705
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014958363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4248266Medicaid