Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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MS. Nicole Theresa Buonanno, PA-C

Individual provider Medical Physician Assistant · NPI 1104983212

MS. Nicole Theresa Buonanno, PA-C is a Physician Assistant in Poughkeepsie, New York. Qualified in 2003, 23 years ago. Practices with Vidant Medical Group LLC, a 974-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
23
Licensed in
NY
In the registry since
2007
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

9 Livingston St Ste 5 - DR Kucherov
Poughkeepsie, NY 12601
Phone: (845) 454-0728
Fax: (845) 454-0914
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 010169-1 (NY)

Record details

NPI number1104983212
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorYes
NPI enumeratedJanuary 2, 2007
Last updated in NPPESJuly 8, 2007

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2003 (23 years in practice)
Group practice Vidant Medical Group Llc — 974 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in Poughkeepsie