Provider Demographics
NPI:1962270918
Name:DEMELLO, BONITA IRENE (CNP (PMHNP))
Entity type:Individual
Prefix:
First Name:BONITA
Middle Name:IRENE
Last Name:DEMELLO
Suffix:
Gender:F
Credentials:CNP (PMHNP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 ANTHONY RD
Mailing Address - Street 2:
Mailing Address - City:FOSTER
Mailing Address - State:RI
Mailing Address - Zip Code:02825-1403
Mailing Address - Country:US
Mailing Address - Phone:401-632-6514
Mailing Address - Fax:
Practice Address - Street 1:17 ADELPHI AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4119
Practice Address - Country:US
Practice Address - Phone:866-708-1240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN03885363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health