Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Bonifasiyo K. Ssennyamantono, MD

Individual provider Cardiovascular Disease Physician · NPI 1902813678

Dr. Bonifasiyo K. Ssennyamantono, MD is a Cardiovascular Disease (Cardiology) in Avondale, Arizona. Graduated from Columbia University College of Physicians and Surgeons in 2000, 26 years ago. Practices with Privia Medical Group Arizona, LLC, a 96-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Arizona.

Years since qualifying
26
Trained at
Columbia University College of Physicians and Surgeons
Licensed in
AZ
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

10815 W McDowell Rd Ste 202
Avondale, AZ 85392-5007
Phone: (623) 433-0202
Fax: (623) 433-0206
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Cardiovascular Disease Physician (primary) Taxonomy 207RC0000X · Licence 35788 (AZ)

Record details

NPI number1902813678
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedAugust 2, 2006
Last updated in NPPESJuly 31, 2024
Certification dateJuly 31, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCARDIOVASCULAR DISEASE (CARDIOLOGY)
Medical schoolCOLUMBIA UNIVERSITY COLLEGE OF PHYSICIANS AND SURGEONS
Graduated 2000 (26 years in practice)
Group practice Privia Medical Group Arizona, Llc — 96 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations15 on file with Medicare

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