Provider Demographics
NPI:1427467745
Name:BONOMO, CHERYL ANN
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ANN
Last Name:BONOMO
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 1:122 STUART AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3130
Mailing Address - Country:US
Mailing Address - Phone:203-853-2834
Mailing Address - Fax:
Practice Address - Street 1:122 STUART AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3130
Practice Address - Country:US
Practice Address - Phone:203-853-2834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000188133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist