Provider Demographics
NPI:1962742379
Name:BRUNI, CRISTINA L (PA)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:L
Last Name:BRUNI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GLEN RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2323
Mailing Address - Country:US
Mailing Address - Phone:716-913-5016
Mailing Address - Fax:
Practice Address - Street 1:2 CORPORATION WAY
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7932
Practice Address - Country:US
Practice Address - Phone:716-913-5016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016389363A00000X
CT6012363A00000X
MAPA5782363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant