Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 228887 | MA |
N | 111NI0900X | Internist | 228887 | MA |
N | 208000000X | Pediatrician | 265991 | NY |
Y | 2080P0201X | Pediatric Allergist | 265991 | NY |
NPI | 1003840760 |
---|---|
Provider Name | Supinda Bunyavanich |
First Address | Boston, MA 02115-6007 |
Second Address | Boston, MA 02115-6007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 31/05/2013 |