Provider Demographics
NPI:1063869303
Name:BONDI, JANE A (MSHS PA-C)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:A
Last Name:BONDI
Suffix:
Gender:F
Credentials:MSHS PA-C
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:BECKA
Other - Last Name:BONDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:2307 W 14TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-3612
Mailing Address - Country:US
Mailing Address - Phone:216-687-4003
Mailing Address - Fax:216-687-4069
Practice Address - Street 1:2307 W 14TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-3612
Practice Address - Country:US
Practice Address - Phone:216-687-4003
Practice Address - Fax:216-687-4069
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.000813RX363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical