Provider Demographics
NPI:1316460413
Name:BONITO, KATHERINE SUSANNE (PA-C)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:SUSANNE
Last Name:BONITO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:SUSANNE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:726 EXCHANGE STREET
Mailing Address - Street 2:SUITE 710
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14210
Mailing Address - Country:US
Mailing Address - Phone:716-852-4772
Mailing Address - Fax:716-314-0421
Practice Address - Street 1:100 HIGH STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203
Practice Address - Country:US
Practice Address - Phone:716-859-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021070363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical