Provider Demographics
NPI:1821633629
Name:BOHUNICKY, ANDREW MICHAEL (PA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:MICHAEL
Last Name:BOHUNICKY
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:3710 EXCHANGE GLENWOOD PL APT 414
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4860
Mailing Address - Country:US
Mailing Address - Phone:607-425-9251
Mailing Address - Fax:
Practice Address - Street 1:115 KILDAIRE PARK DR STE 108
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8144
Practice Address - Country:US
Practice Address - Phone:919-469-1252
Practice Address - Fax:919-469-1373
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2021-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-09487363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant