Provider Demographics
NPI:1639905136
Name:BRUNI, AMELIA
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:BRUNI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8563 ANGELA DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-5419
Mailing Address - Country:US
Mailing Address - Phone:586-291-1730
Mailing Address - Fax:
Practice Address - Street 1:8563 ANGELA DR
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-5419
Practice Address - Country:US
Practice Address - Phone:586-291-1730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical