Provider Demographics
NPI:1033134820
Name:BENCI, VIVIAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:M
Last Name:BENCI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 SUNNYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-6454
Mailing Address - Country:US
Mailing Address - Phone:727-741-8118
Mailing Address - Fax:
Practice Address - Street 1:1621 SUNNYBROOK LN
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-6454
Practice Address - Country:US
Practice Address - Phone:727-741-8118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56866207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271988600Medicaid
FL271988600Medicaid
FL271988600Medicaid